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Llop M, Gratacós J, Moreno M, Arevalo Salaet M, Calvet J, Berenguer-Llergo A, Dougados M, Molto A, López-Medina C. Sex differential impact of comorbidities in spondyloarthritis: data from COMOSPA study. RMD Open 2024; 10:e003776. [PMID: 38296312 PMCID: PMC10836353 DOI: 10.1136/rmdopen-2023-003776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/09/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES To describe and compare the prevalence of comorbidities in female and male patients with spondyloarthritis (SpA) and to assess whether comorbidities had a different impact on disease outcomes in male and female patients. METHODS This is a post hoc analysis of the COMOrbidities in SPondyloArthritis study. Differences in comorbidities regarding sex were assessed using logistic regression models. Comorbidities were evaluated for their impact on disease outcomes (Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Ankylosing Spondylitis Disease Activity Score (ASDAS), Bath Ankylosing Spondylitis Functional Index, European health-related quality of life questionnaire) with linear models, which included sex and comorbidity as explanatory variables and their interaction. Age and treatment with biological synthetic disease-modifying antirheumatic drugs were included as confounders. RESULTS We included 3982 patients with SpA (65% male, mean age 43.6 years). Male and female patients with SpA exhibited similar comorbidity profiles, except for a low prevalence of fibromyalgia in males and a higher prevalence of certain cardiovascular risk factors in males (hypertension, dyslipidaemia, renal impairment and ischaemic heart disease). Comorbidities, especially fibromyalgia, correlated with higher disease activity, decreased physical function and reduced health-related quality of life in both sexes. Some comorbidities exhibited sex-specific associations with disease outcomes. Peptic ulcers and high waist circumference had a greater impact on disease activity in females (with a higher impact in BASDAI than in ASDAS). In contrast, osteoporosis had a more pronounced effect on physical function in male patients. CONCLUSIONS Comorbidities exert distinct influences on disease activity, physical function and health-related quality of life in male and female patients with SpA. Understanding these sex-specific effects is crucial for improving SpA management, emphasising the importance of assessing disease activity using ASDAS when comorbidities are present to mitigate sex-related disparities in disease assessment.
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Affiliation(s)
- Maria Llop
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
- Medicine department Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Mireia Moreno
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Marta Arevalo Salaet
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Joan Calvet
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Antoni Berenguer-Llergo
- Biostatistics and Bioinformatics Rheumatology Department, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | | | - Anna Molto
- Rheumatology, Hospital Cochin, Paris, France
- ECAMO team - INSERM (U1153) - Center of Research in Epidemiology and Statistics (CRESS) - Université Paris-Cité, Paris, France
| | - Clementina López-Medina
- Rheumatology Department, Hospital Universitario Reina Sofía/IMIBIC/Universidad de Córdoba, Córdoba, Spain
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Calvet J, Berenguer-Llergo A, Orellana C, García-Manrique M, Rusiñol M, Garcia-Cirera S, Llop M, Arévalo M, Garcia-Pinilla A, Galisteo C, Aymerich C, Gómez R, Serrano A, Carreras A, Gratacós J. Specific-cytokine associations with outcomes in knee osteoarthritis subgroups: breaking down disease heterogeneity with phenotyping. Arthritis Res Ther 2024; 26:19. [PMID: 38212829 PMCID: PMC10782658 DOI: 10.1186/s13075-023-03244-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Despite existing extensive literature, a comprehensive and clinically relevant classification system for osteoarthritis (OA) has yet to be established. In this study, we aimed to further characterize four knee OA (KOA) inflammatory phenotypes (KOIP) recently proposed by our group, by identifying the inflammatory factors associated with KOA severity and progression in a phenotype-specific manner. METHODS We performed an analysis within each of the previously defined four KOIP groups, to assess the association between KOA severity and progression and a panel of 13 cytokines evaluated in the plasma and synovial fluid of our cohort's patients. The cohort included 168 symptomatic female KOA patients with persistent joint effusion. RESULTS Overall, our analyses showed that associations with KOA outcomes were of higher magnitude within the KOIP groups than for the overall patient series (all p-values < 1.30e-16) and that several of the cytokines showed a KOIP-specific behaviour regarding their associations with KOA outcomes. CONCLUSION Our study adds further evidence supporting KOA as a multifaceted syndrome composed of multiple phenotypes with differing pathophysiological pathways, providing an explanation for inconsistencies between previous studies focussed on the role of cytokines in OA and the lack of translational results to date. Our findings also highlight the potential clinical benefits of accurately phenotyping KOA patients, including improved patient stratification, tailored therapies, and the discovery of novel treatments.
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Affiliation(s)
- Joan Calvet
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
| | - Antoni Berenguer-Llergo
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Cristóbal Orellana
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - María García-Manrique
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Menna Rusiñol
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Silvia Garcia-Cirera
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Maria Llop
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Marta Arévalo
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Alba Garcia-Pinilla
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Carlos Galisteo
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Cristina Aymerich
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Rafael Gómez
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Alejandra Serrano
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Anna Carreras
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
| | - Jordi Gratacós
- Department of Rheumatology, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, c/Parc Taulí s/n, edifici VII Centenari, 08208, Sabadell, Spain
- Department of Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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Garcia-Cirera S, Calvet J, Delgado de la Poza JF, Berenguer-Llergo A, Orellana C, Rusiñol M, Llop M, Arévalo M, Garcia-Pinilla A, Costa E, Aymerich C, Gómez R, Carreras A, Gratacós J. Biological and glucocorticoids treatment impair the medium-term immunogenicity to SARS-CoV-2 mRNA vaccines in autoimmune inflammatory rheumatic diseases. Eur J Med Res 2024; 29:28. [PMID: 38183092 PMCID: PMC10768211 DOI: 10.1186/s40001-023-01620-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/24/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND This study aims to assess the sustained immunological response to the SARS-CoV-2 vaccine in patients with autoimmune inflammatory rheumatic diseases (AIRD) undergoing different treatment regimens. METHODS We conducted a prospective observational study involving 157 AIRD patients without prior COVID-19 infection. Treatment regimens included non-treatment or glucocorticoid-only (not-treated/GCs), non-biological drugs, biological therapy, and JAK inhibitors. All participants completed the two-dose vaccine schedule, and 110 of them received an additional booster dose. Serum samples were collected approximately 3-6 months after the second and third vaccine doses to measure antibodies against the Spike protein (antiS-AB) and neutralizing antibodies (nAB) targeting six SARS-CoV-2 variants. RESULTS Following the third dose, all patients exhibited a significant increase in antiS-AB (FC = 15, p < 0.0001). Patients under biological therapy had lower titres compared to the non-biological (66% decrease, p = 0.038) and the not-treated/GCs group (62% decrease, p = 0.0132), with the latter persisting after the booster dose (86% decrease, p = 0.0027). GC use was associated with lower antiS-AB levels in the biological group (87% decrease, p = 0.0124), although not statistically significant after confounders adjustment. nABs showed the highest positivity rates for the wild-type strain before (50%) and after the booster dose (93%), while the Omicron variant exhibited the lowest rates (11% and 55%, respectively). All variants demonstrated similar positivity patterns and good concordance with antiS-AB (AUCs from 0.896 to 0.997). CONCLUSIONS The SARS-CoV-2 vaccine booster strategy effectively elicited a sustained antibody immune response in AIRD patients. However, patients under biological therapies exhibited a reduced response to the booster dose, particularly when combined with GCs.
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Affiliation(s)
- Silvia Garcia-Cirera
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), 08003, Barcelona, Spain
| | - Joan Calvet
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain.
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), 08003, Barcelona, Spain.
| | - Juan Francisco Delgado de la Poza
- Immunology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), 08208, Sabadell, Spain
| | - Antoni Berenguer-Llergo
- Rheumatology Department, Biostatistics and Bioinformatics at Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), 08028, Sabadell, Spain
| | - Cristóbal Orellana
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Menna Rusiñol
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Maria Llop
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Marta Arévalo
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Alba Garcia-Pinilla
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Ester Costa
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Cristina Aymerich
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Rafael Gómez
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Anna Carreras
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Hospital Universitari. Institut d'Investigació I Innovació Parc Taulí (I3PT-CERCA), c/Parc Taulí S/N, Edifici VII Centenari, 08208, Sabadell, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), 08003, Barcelona, Spain
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Calvet J, García-Manrique M, Berenguer-Llergo A, Orellana C, Cirera SG, Llop M, Galisteo Lencastre C, Arévalo M, Aymerich C, Gómez R, Giménez NA, Gratacós J. Metabolic and inflammatory profiles define phenotypes with clinical relevance in female knee osteoarthritis patients with joint effusion. Rheumatology (Oxford) 2023; 62:3875-3885. [PMID: 36944271 PMCID: PMC10691929 DOI: 10.1093/rheumatology/kead135] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/12/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
OBJECTIVES Osteoarthritis has been the subject of abundant research in the last years with limited translation to the clinical practice, probably due to the disease's high heterogeneity. In this study, we aimed to identify different phenotypes in knee osteoarthritis (KOA) patients with joint effusion based on their metabolic and inflammatory profiles. METHODS A non-supervised strategy based on statistical and machine learning methods was applied to 45 parameters measured on 168 female KOA patients with persistent joint effusion, consecutively recruited at our hospital after a monographic OA outpatient visit. Data comprised anthropometric and metabolic factors and a panel of systemic and local inflammatory markers. The resulting clusters were compared regarding their clinical, radiographic and ultrasound severity at baseline and their radiographic progression at two years. RESULTS Our analyses identified four KOA inflammatory phenotypes (KOIP): a group characterized by metabolic syndrome, probably driven by body fat and obesity, and by high local and systemic inflammation (KOIP-1); a metabolically healthy phenotype with mild overall inflammation (KOIP-2); a non-metabolic phenotype with high inflammation levels (KOIP-3); and a metabolic phenotype with low inflammation and cardiovascular risk factors not associated with obesity (KOIP-4). Of interest, these groups exhibited differences regarding pain, functional disability and radiographic progression, pointing to a clinical relevance of the uncovered phenotypes. CONCLUSION Our results support the existence of different KOA phenotypes with clinical relevance and differing pathways regarding their pathophysiology and disease evolution, which entails implications in patients' stratification, treatment tailoring and the search of novel and personalized therapies.
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Affiliation(s)
- Joan Calvet
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - María García-Manrique
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Antoni Berenguer-Llergo
- Rheumatology Department, Biostatistics and Bioinformatics, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Cristóbal Orellana
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Silvia Garcia Cirera
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Maria Llop
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Carlos Galisteo Lencastre
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Marta Arévalo
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Cristina Aymerich
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Rafael Gómez
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
| | - Néstor Albiñana Giménez
- Scientific-Technical Unit, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA) (UAB), Sabadell, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Sabadell, Spain
- Departament de Medicina, Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
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Navarro-Compán V, Puig L, Vidal S, Ramírez J, Llamas-Velasco M, Fernández-Carballido C, Almodóvar R, Pinto JA, Galíndez-Aguirregoikoa E, Zarco P, Joven B, Gratacós J, Juanola X, Blanco R, Arias-Santiago S, Sanz JS, Queiro R, Cañete JD. Corrigendum: The paradigm of IL-23-independent production of IL-17F and IL-17A and their role in chronic inflammatory diseases. Front Immunol 2023; 14:1332177. [PMID: 38077344 PMCID: PMC10699169 DOI: 10.3389/fimmu.2023.1332177] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 11/13/2023] [Indexed: 01/06/2024] Open
Abstract
[This corrects the article DOI: 10.3389/fimmu.2023.1191782.].
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Affiliation(s)
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Silvia Vidal
- Immunology-Inflammatory Diseases, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Julio Ramírez
- Arthritis Unit, Department of Rheumatology, Hospital Clínic and Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Raquel Almodóvar
- Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - José Antonio Pinto
- Department of Rheumatology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | | | - Pedro Zarco
- Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Beatriz Joven
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jordi Gratacós
- Department of Rheumatology, Medicine Department Autonomus University of Barcelona (UAB), I3PT, University Hospital Parc Taulí Sabadell, Barcelona, Spain
| | - Xavier Juanola
- Department of Rheumatology, University Hospital Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Ricardo Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Salvador Arias-Santiago
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Dermatology, Facultad de Medicina, Universidad de Granada, Granada, Spain
| | - Jesús Sanz Sanz
- Department of Rheumatology, Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain
| | - Rubén Queiro
- Department of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Juan D. Cañete
- Arthritis Unit, Department of Rheumatology, Hospital Clínic and Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Urruticoechea-Arana A, Sanz J, Ginard D, González-Lama Y, Juanola X, Almirall M, Borruel N, Gratacós J, Loza E. Implementation of the recommendations for the psychological management of patients with spondyloarthritis and inflammatory bowel disease. Reumatol Clin (Engl Ed) 2023; 19:423-429. [PMID: 37805255 DOI: 10.1016/j.reumae.2023.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 03/07/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVE To assess and improve the level of implementation of the recommendations for the psychological management of patients with spondyloarthritis (SpA) and associated inflammatory bowel disease (IBD). METHODS Qualitative study. We performed a narrative literature review to identify the recommendations for the psychological management of SpA and associated IBD and to explore their level of implementation. Based on the findings, we developed a national survey to assess: (1) current level of knowledge and implementation of the recommendations; (2) attitudes towards the recommendations; and (3) barriers and facilitators to their implementation. The results of the review and survey were discussed by a multidisciplinary group of 9 expert rheumatologists and gastroenterologists, who defined implementation strategies to increase the uptake of the recommendations. RESULTS The review included 4 articles, 2 of them included direct recommendations on the identification and management of psychological problems in patients with SpA and IBD. None assessed the level of implementation of the recommendations in routine clinical practice. Our survey showed a great lack of awareness and implementation of the recommendations, even though psychological issues are very relevant for health professionals. Lack of time, resources, and knowledge are considered the main barriers to adherence to the recommendations. We propose several implementation strategies related to educational activities, clinical practice, and others to increase the uptake of reported recommendations. CONCLUSIONS Further research and efforts are required to achieve behaviour changes in clinical practice to improve the identification and management of psychological problems and needs in patients with SpA and IBD.
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Affiliation(s)
| | - Jesús Sanz
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Daniel Ginard
- Servicio de Gastroenterología, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Yago González-Lama
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Gastroenterología y Hepatología, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitario Bellvitge, IDIBELL, Barcelona, Spain
| | - Miriam Almirall
- Servicio de Reumatología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - Natalia Borruel
- Unidad de atención Crohn-Colitis (UACC), Servicio del Aparato Digestivo, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Jordi Gratacós
- Servicio de Reumatología, Hospital Universitario Parc Taulí Sabadell, I3PT, Departamento de Medicina UAB, Barcelona, Spain
| | - Estíbaliz Loza
- Instituto de Salud Musculoesquelética (InMusc), Madrid, Spain.
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Puche-Larrubia MÁ, Ladehesa-Pineda L, Vázquez-Mellado J, Escudero-Contreras A, Gratacós J, Juanola X, Collantes-Estévez E, Font-Ugalde P, López-Medina C. Identification of the first signs or symptoms in different spondyloarthritis subtypes and their association with HLA-B27: data from REGISPONSER and RESPONDIA registries. RMD Open 2023; 9:e003235. [PMID: 37734875 PMCID: PMC10514611 DOI: 10.1136/rmdopen-2023-003235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE To describe and analyse the initial symptoms attributable to patients with spondyloarthritis (SpA) and their association with HLA-B27 status. METHODS This was an observational, cross-sectional and multicentre study with patients who fulfilled the European Spondyloarthropathy Study Group criteria for SpA from the Registry of Spondyloarthritis of Spanish Rheumatology (REGISPONSER) and Ibero-American Registry of Spondyloarthropathies (RESPONDIA) united registries. Differences in the first sign(s) or symptom(s) were compared across diagnoses and between HLA-B27 status. The diagnostic delay between patients who start the disease with musculoskeletal manifestations (MMs) and extra-MMs (EMMs) was compared. RESULTS A total of 4067 patients were included (2208 from REGISPONSER and 1859 from RESPONDIA) (ankylosing spondylitis (AS): 68.3%, psoriatic arthritis (PsA): 19.9%, undifferentiated SpA: 11.8%). Overall, 3624 (89.1%) patients initiated the disease with MMs and 443 (10.9%) with EMMs. Low back pain (61.7%) and lower-limb arthritis (38.5%) were the most frequent initial symptoms. In AS patients, the absence of HLA-B27 seems to be related to an increase in the probability of starting the disease with cervical pain and peripheral manifestations. In PsA, the onset of arthritis and psoriasis was more prevalent in HLA-B27-negative patients, while initiation with axial manifestations was more predominant in HLA-B27-positive patients. The diagnostic delay was longer in patients with initial MMs than in those with EMMs (7.2 (34.8) vs 4.5 (7.6) years, respectively). CONCLUSION In this SpA population, MMs were the most prevalent initial symptoms, with differences across diagnoses and depending on the presence of the HLA-B27 antigen.
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Affiliation(s)
- María Ángeles Puche-Larrubia
- Department of Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- GC-05 Group, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Lourdes Ladehesa-Pineda
- Department of Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- GC-05 Group, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | | | - Alejandro Escudero-Contreras
- Department of Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- GC-05 Group, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Jordi Gratacós
- Department of Rheumatology, Hospital Universitario Parc Taulí, Barcelona, Spain
| | - Xavier Juanola
- Department of Rheumatology, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Eduardo Collantes-Estévez
- GC-05 Group, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Pilar Font-Ugalde
- GC-05 Group, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
| | - Clementina López-Medina
- Department of Rheumatology, Reina Sofia University Hospital, Cordoba, Spain
- GC-05 Group, Maimonides Institute for Biomedical Research of Cordoba (IMIBIC), Cordoba, Spain
- Medical and Surgical Sciences, University of Cordoba, Cordoba, Spain
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8
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Navarro-Compán V, Puig L, Vidal S, Ramírez J, Llamas-Velasco M, Fernández-Carballido C, Almodóvar R, Pinto JA, Galíndez-Aguirregoikoa E, Zarco P, Joven B, Gratacós J, Juanola X, Blanco R, Arias-Santiago S, Sanz Sanz J, Queiro R, Cañete JD. The paradigm of IL-23-independent production of IL-17F and IL-17A and their role in chronic inflammatory diseases. Front Immunol 2023; 14:1191782. [PMID: 37600764 PMCID: PMC10437113 DOI: 10.3389/fimmu.2023.1191782] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 07/05/2023] [Indexed: 08/22/2023] Open
Abstract
Interleukin-17 family (IL-17s) comprises six structurally related members (IL-17A to IL-17F); sequence homology is highest between IL-17A and IL-17F, displaying certain overlapping functions. In general, IL-17A and IL-17F play important roles in chronic inflammation and autoimmunity, controlling bacterial and fungal infections, and signaling mainly through activation of the nuclear factor-kappa B (NF-κB) pathway. The role of IL-17A and IL-17F has been established in chronic immune-mediated inflammatory diseases (IMIDs), such as psoriasis (PsO), psoriatic arthritis (PsA), axial spondylarthritis (axSpA), hidradenitis suppurativa (HS), inflammatory bowel disease (IBD), multiple sclerosis (MS), and asthma. CD4+ helper T cells (Th17) activated by IL-23 are well-studied sources of IL-17A and IL-17F. However, other cellular subtypes can also produce IL-17A and IL-17F, including gamma delta (γδ) T cells, alpha beta (αβ) T cells, type 3 innate lymphoid cells (ILC3), natural killer T cells (NKT), or mucosal associated invariant T cells (MAIT). Interestingly, the production of IL-17A and IL-17F by innate and innate-like lymphocytes can take place in an IL-23 independent manner in addition to IL-23 classical pathway. This would explain the limitations of the inhibition of IL-23 in the treatment of patients with certain rheumatic immune-mediated conditions such as axSpA. Despite their coincident functions, IL-17A and IL-17F contribute independently to chronic tissue inflammation having somehow non-redundant roles. Although IL-17A has been more widely studied, both IL-17A and IL-17F are overexpressed in PsO, PsA, axSpA and HS. Therefore, dual inhibition of IL-17A and IL-17F could provide better outcomes than IL-23 or IL-17A blockade.
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Affiliation(s)
| | - Luis Puig
- Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Silvia Vidal
- Immunology-Inflammatory Diseases, Institut de Recerca de l’Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Julio Ramírez
- Arthritis Unit, Department of Rheumatology, Hospital Clínic and Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mar Llamas-Velasco
- Department of Dermatology, Hospital Universitario La Princesa, Madrid, Spain
| | | | - Raquel Almodóvar
- Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - José Antonio Pinto
- Department of Rheumatology, Complejo Hospitalario Universitario de A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain
| | | | - Pedro Zarco
- Department of Rheumatology, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
| | - Beatriz Joven
- Department of Rheumatology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Jordi Gratacós
- Department of Rheumatology, Medicine Department Autonomus University of Barcelona (UAB), I3PT, University Hospital Parc Taulí Sabadell, Barcelona, Spain
| | - Xavier Juanola
- Department of Rheumatology, University Hospital Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, Spain
| | - Ricardo Blanco
- Department of Rheumatology, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain
| | - Salvador Arias-Santiago
- Department of Dermatology, Hospital Universitario Virgen de las Nieves, Granada, Spain
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
- Department of Dermatology, Facultad de Medicina, Universidad de Granada, Spain
| | - Jesús Sanz Sanz
- Department of Rheumatology, Hospital Universitario Puerta del Hierro Majadahonda, Madrid, Spain
| | - Rubén Queiro
- Department of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Juan D. Cañete
- Arthritis Unit, Department of Rheumatology, Hospital Clínic and Instituto de Investigaciones Biomédicas August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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9
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Delgado JF, Vidal M, Julià G, Navarro G, Serrano RM, van den Eynde E, Navarro M, Calvet J, Gratacós J, Espasa M, Peña P. Validation of N Protein Antibodies to Diagnose Previous SARS-CoV-2 Infection in a Large Cohort of Healthcare Workers: Use of Roche Elecsys ® Immunoassay in the S Protein Vaccination Era. Viruses 2023; 15:v15040930. [PMID: 37112910 PMCID: PMC10146079 DOI: 10.3390/v15040930] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
The aim of this study was to validate the detection of anti-nucleocapsid protein (N protein) antibodies for the diagnosis of SARS-CoV-2 infection in light of the fact that most COVID-19 vaccines use the spike (S) protein as the antigen. Here, 3550 healthcare workers (HCWs) were enrolled from May 2020 (when no S protein vaccines were available). We defined SARS-CoV-2 infection if HCWs were found to be positive by RT-PCR or found to be positive in at least two different serological immunoassays. Serum samples from Biobanc I3PT-CERCA were analyzed by Roche Elecsys® (N protein) and Vircell IgG (N and S proteins) immunoassays. Discordant samples were reanalyzed with other commercial immunoassays. Roche Elecsys® showed the positivity of 539 (15.2%) HCWs, 664 (18.7%) were found to be positive by Vircell IgG immunoassays, and 164 samples (4.6%) showed discrepant results. According to our SARS-CoV-2 infection criteria, 563 HCWs had SARS-CoV-2 infection. The Roche Elecsys® immunoassay has a sensitivity, specificity, accuracy, and concordance with the presence of infection of 94.7%, 99.8%, 99.3%, and 0.96, respectively. Similar results were observed in a validation cohort of vaccinated HCWs. We conclude that the Roche Elecsys® SARS-CoV-2 N protein immunoassay demonstrated good performance in diagnosing previous SARS-CoV-2 infection in a large cohort of HCWs.
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Affiliation(s)
- Juan Francisco Delgado
- Immunology Laboratory, Clinic Laboratories Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Mònica Vidal
- Immunology Laboratory, Clinic Laboratories Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Germà Julià
- Immunology Laboratory, Clinic Laboratories Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Gema Navarro
- Epidemiology Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Rosa María Serrano
- Occupational Health Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Eva van den Eynde
- Infection Disease Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Marta Navarro
- Infection Disease Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Joan Calvet
- Rheumatology Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Jordi Gratacós
- Rheumatology Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Departament de Medicina, Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Mateu Espasa
- Microbiology Section, Laboratory Service, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
| | - Pilar Peña
- Occupational Health Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT-CERCA), Universitat Autònoma de Barcelona, 8207 Sabadell, Spain
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10
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Gratacós J, Pablos JL, de Miguel E, Juanola X, Fernández-Carballido C, Ariza R, Terradas-Montana P, Sastré C, Sanabra C. Disease control in patients with psoriatic arthritis in real clinical practice in Spain: MiDAS study. Reumatol Clin (Engl Ed) 2023; 19:204-210. [PMID: 37061282 DOI: 10.1016/j.reumae.2022.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/29/2022] [Indexed: 04/17/2023]
Abstract
OBJECTIVE MiDAS study assessed the percentage of psoriatic arthritis (PsA) patients treated in routine clinical practice who achieved control of disease activity according to Disease Activity in Psoriatic Arthritis (DAPSA) and Minimal Disease Activity (MDA). METHODS Observational, non-interventional, cross-sectional, multicenter study conducted under conditions of routine clinical practice in 36 centers with outpatient rheumatology clinics in Spanish public hospitals. Patients included were adults (≥18 years) with ≥6 months PsA diagnosis according to classification for PsA (CASPAR) criteria and undergoing treatment ≥3 months. The main variable evaluated was the percentage of patients under remission and low disease activity, assessed through DAPSA and MDA. RESULTS 313 patients with PsA were included: 54.3% male; with mean age of 54.1±12.2 years and mean disease duration of 10.5±9.0 years. Mean C-reactive protein (CRP) serum levels were 4.9±7.3mg/L. At the study visit, 58.5% of patients were in monotherapy (17.6% biological and 40.9% non-biological) and 41.2% were receiving biological and non-biological therapy. 59.4% of patients showed low disease activity (DAPSA≤14) and 19.8% were on remission (DAPSA≤4). Moreover, 51.4% of the patients reached an MDA status (≥5 MDA). CONCLUSIONS Around 40% of PsA patients presented uncontrolled disease, highlighting the need to improve the management of these patients in clinical practice.
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Affiliation(s)
- Jordi Gratacós
- Rheumatology Department, Hospital Universitario Parc Taulí Sabadell, Departamento Medicina UAB, Spain
| | - José L Pablos
- Rheumatology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Eugenio de Miguel
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Xavier Juanola
- Rheumatology Department, Hospital Universitari Bellvitge, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Rafael Ariza
- Rheumatology Department, Hospital Universitario Virgen de Macarena, Sevilla, Spain
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11
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Garrido-Cumbrera M, Collantes-Estévez E, Navarro-Compán V, Zarco-Montejo P, Sastre C, Correa-Fernández J, Gratacós J. Patients with Axial Spondyloarthritis are Great Consumers of Healthcare Resources, Especially Young and Women: Results from the Spanish Atlas. Rheumatol Ther 2023; 10:729-739. [PMID: 36877341 PMCID: PMC10140249 DOI: 10.1007/s40744-023-00543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 02/13/2023] [Indexed: 03/07/2023] Open
Abstract
INTRODUCTION This study aimed to assess high healthcare utilization over 1 year in patients with axial spondyloarthritis (axSpA) and factors associated with increased healthcare utilization. METHODS A total of 530 unselected patients with axSpA from the Atlas of Axial Spondyloarthritis in Spain-who had used at least one healthcare resource-were included in the present study. Total health care utilization was obtained from the total number of healthcare visits, medical tests, hospital admissions and emergency visits, during the 12 months prior to the survey. Linear regression was used to analyse possible factors associated with higher healthcare utilization. RESULTS A total of 530 patients with axSpA participated in this study: mean age was 45.3 years and 51.1% were female. In the previous 12 months, 77.9% (n = 530) used at least one healthcare resource, with the median healthcare utilization at 25. In the multiple linear regression, the only categorical factor associated with higher healthcare utilization was female gender (β = 12.854), while the continuous factors associated with higher healthcare utilization were higher disease activity (β = 3.378), longer diagnostic delay (β = 0.959), younger age (β = - 0.737) and greater functional limitation (β = 0.576). CONCLUSION Half of patients with axSpA used 25 or more healthcare resources during 1 year. Higher healthcare utilization was associated with younger age, female gender, greater disease activity, higher functional limitation and longer diagnostic delay. Optimal monitoring of patients with axSpA may help to reduce their healthcare utilization.
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Affiliation(s)
- Marco Garrido-Cumbrera
- Health & Territory Research (HTR), Universidad de Sevilla, Seville, Spain. .,Spanish Federation of Spondyloarthritis Associations (CEADE), Madrid, Spain. .,Axial Spondiloarthritis International Federation (ASIF), London, UK.
| | - Eduardo Collantes-Estévez
- Reina Sofia University Hospital, Cordoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Cordoba, Spain
| | | | | | | | | | - Jordi Gratacós
- Hospital Universitari Parc Taulí, Sabadell, Spain.,I3PT, Medicine Department UAB, Barcelona, Spain
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12
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Almodóvar R, Cañete JD, Collantes E, de Miguel E, Fernández Carballido C, Gratacós J, Juanola X, Pinto JA, Queiro R, Zarco P. Strategies and resources to optimise the management of Psoriatic Arthritis patients: The CREA Project. Reumatol Clin (Engl Ed) 2023; 19:159-167. [PMID: 36068162 DOI: 10.1016/j.reumae.2022.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/27/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIM Psoriatic arthritis (PsA) is a chronic immune-mediated inflammatory disease that affects the musculoskeletal system and skin, and manifests heterogeneously, with a variable course. In current clinical practice, variability and limitations in its follow-up have been observed. The aim of the CREA project was to agree on strategies to improve the initial assessment and follow-up of patients with PsA in Spain. MATERIALS AND METHODS A survey was conducted among a representative sample of expert rheumatologists in Spain, containing 33 questions on current clinical practice, available resources, and current limitations in the follow-up of patients with PsA. The results were discussed in regional meetings and 105 strategies were proposed and finally evaluated by 85 experts in a Delphi consensus. RESULTS The most important limitations in the follow-up of PsA were lack of consultation time, lack of nursing staff, and delays in performing imaging tests. A total of 108 strategies were proposed related to the assessment of quality of life and disease-impact indices; comorbidities and extra-articular manifestations; laboratory tests; imaging tests; physical examination and metrology; and activity and function indices. Of the total, 53 were considered highly advisable, with no regional differences in consensus values. DISCUSSION AND CONCLUSIONS The proposals offered in the current study are applicable to the entire country, respond to the unmet needs detected in the initial survey, form a minimum action framework, and ensure optimal follow-up of patients with PsA.
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Affiliation(s)
- Raquel Almodóvar
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain.
| | | | - Eduardo Collantes
- Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | | | - Jordi Gratacós
- Hospital Universitario Parc Taulí, Sabadell, Spain; Grupo investigación A8G2 del I3PT, Departamento de Medicina de la UAB, Barcelona, Spain
| | | | - José A Pinto
- Complejo Hospitalario Universitario, de A Coruña, INIBIC, A Coruña, Spain
| | - Rubén Queiro
- Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pedro Zarco
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
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13
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Fernández-Carballido C, Almodóvar R, Cañete JD, Collantes E, de Miguel E, Gratacós J, Juanola X, Pinto JA, Queiro R, Zarco P. Resources and strategies for the optimal care of patients with axial spondyloarthritis: The CREA project. Reumatol Clin (Engl Ed) 2023; 19:82-89. [PMID: 36064886 DOI: 10.1016/j.reumae.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/03/2022] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Axial spondyloarthritis (axSpA) are musculoskeletal diseases with different manifestations. In clinical practice, variability, and limitations in the collection of the outcomes required for follow-up have been observed. The objective of the CREA project was to agree on improvement strategies for the initial assessment and follow-up of patients with axSpA in Spain. MATERIALS AND METHODS A survey with 33 questions was conducted by a representative sample of rheumatologists on clinical practice, resources, and present limitations in the follow-up of patients with axSpA. The results of the survey were discussed in 10 regional meetings, and 105 strategies were proposed and evaluated through a Delphi consensus in which 85 experts participated. RESULTS The lack of time for clinical visits, the lack of nurses and/or support staff and the delay in performing the imaging tests were the most prominent limitations in the follow-up of patients with axSpA. One hundred and five strategies were proposed related to the evaluation of disease activity, physical function, quality of life and disease impact, to the evaluation of comorbidities and extra-articular manifestations, laboratory tests; imaging tests, physical examination and metrology. Of the total, 85 were considered highly advisable. No regional differences were found. CONCLUSIONS The proposals agreed upon as highly advisable in the present study are applicable to the entire national territory, allow tighter and more homogeneous monitoring of the patients with axSpA, facilitate more comprehensive management of the disease, and respond to the unmet needs detected in the initial survey.
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Affiliation(s)
| | | | | | - Eduardo Collantes
- Hospital Universitario Reina Sofía, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain
| | | | - Jordi Gratacós
- Hospital Universitario Parc Taulí, Sabadell, Spain; Grupo investigación A8G2 del I3PT, Departamento de Medicina, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | | | - José A Pinto
- Complejo Hospitalario Universitario de A Coruña, INIBIC, A Coruña, Spain
| | - Rubén Queiro
- Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Pedro Zarco
- Hospital Universitario Fundación Alcorcón, Madrid, Spain
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14
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Arevalo Salaet M, López-Medina C, Moreno M, Navarro-Compan V, Calvet Fontova J, Llop M, Dougados M, Gratacós J. Association between HLA-B27 and peripheral spondyloarthritis phenotype: results from the ASAS perSpA study. RMD Open 2022; 8:rmdopen-2022-002696. [PMID: 36597968 PMCID: PMC9743377 DOI: 10.1136/rmdopen-2022-002696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To analyse the influence of HLA-B27 in the phenotypical expression of peripheral spondyloarthritis (pSpA). METHOD This is an observational cross-sectional study using data from the Assessment of SpondyloArthritis international Society perSpA registry, including all patients with an available HLA-B27 test result and with a diagnosis of pSpA or psoriatic arthritis (PsA) as per rheumatologist's judgement. Demographic and clinical data, presence of extra musculoskeletal manifestations (EMM) and fibromyalgia were the variables included in a simple and multiple logistic regression model to assess their association to HLA-B27 positivity. RESULTS From the 4465 patients included in the registry, 790 were classified as having either pSpA or PsA and had the HLA-B27 typing available. HLA-B27-positive patients presented a male predominance, had an earlier disease onset and a shorter diagnostic delay compared with the negatives. HLA-B27-positive patients presented a higher frequency of axial involvement, radiographic sacroiliitis, enthesitis and uveitis. Also, root joint involvement, poliarticular joint patern and tarsitis were significantly higher within HLA-B27-positive patients. Furthermore, we did not observe any association between the presence of HLA-B27 and peripheral joint damage, dactylitis, other EMM (psoriasis, inflammatory bowel disease) or fibromyalgia.The multivariable analysis confirmed the independent association of HLA-B27 positivity with male sex, an earlier onset of the disease, the presence of axial involvement, tarsitis and uveitis. SUMMARY In summary, the presence of HLA-B27 in pSpA patients was associated with earlier disease onset and higher axial involvement, tarsitis and uveitis, but not with other EMM, fibromyalgia or peripheral structural damage.
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Affiliation(s)
- Marta Arevalo Salaet
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Medicine Department, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Clementina López-Medina
- Department of Rheumatology, Hôpital Cochin. Assistance Publique - Hôpitaux de ParisINSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Université de Paris, Paris, France,Rheumatology Department, Hospital Universitario Reina Sofía/IMIBIC/Universidad de Córdoba, Córdoba, Spain
| | - Mireia Moreno
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Medicine Department, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | - Joan Calvet Fontova
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Medicine Department, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Maria Llop
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Medicine Department, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Maxime Dougados
- Department of Rheumatology, Hôpital Cochin. Assistance Publique - Hôpitaux de ParisINSERM (U1153): Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Université de Paris, Paris, France
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Medicine Department, Universitat Autònoma de Barcelona, Sabadell, Spain
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15
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Llop M, Gratacós J, Moreno M, Arévalo M, Calvet J, Dougados M, López-Medina C. Uveitis in peripheral spondyloarthritis patients: an ancillary analysis of the ASAS-PerSpA study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221119246. [PMID: 36081747 PMCID: PMC9445458 DOI: 10.1177/1759720x221119246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022] Open
Abstract
Background: Acute anterior uveitis (AAU) is the most frequent extra-musculoskeletal manifestation in spondyloarhtritis (SpA). Previous data on AAU focused on axial disease; therefore, it is not well known whether the clinical characteristics of patients with AAU and recurrent AAU differ between patients with axial and peripheral SpA. Objective: Primary objective was to compare the clinical characteristics of patients with AAU from patients without AAU in axial and peripheral spondyloarthritis (SpA) patients. Secondary objectives were to describe the clinical features of patients with AAU in the subset of patients with peripheral SpA (pSpA) and the clinical characteristics of patients with recurrent AAU in SpA patients. Design: This is an ancillary analysis of the ASAS-PerSpA study which included 3152 patients, 2719 patients with axSpA and 433 with pSpA according to rheumatologist judgement. Methods: Recurrent AAU was defined as the presence of two or more episodes of AAU ever. Univariable and multivariable binary logistic regression analyses were conducted to identify factors associated with the presence of AAU ever and the presence of recurrent AAU. Results: Overall, 663 patients (21%) presented AAU. Of them, 444 (66.9%) presented recurrent episodes. In patients with SpA, HLA-B27 positivity is the most important factor linked to the presence of AAU, odds ratio (OR) = 2.70 (95% CI = 2.04–3.6). In patients with pSpA, HLA-B27 positivity was also the most relevant factor linked to the presence of AAU, OR = 6.08 (95% CI = 2.72–15.68). Moreover, disease duration, younger age and higher body mass index (BMI) were the only factors slightly linked to the presence of recurrent episodes, OR = 1.03 (95% CI = 1.01–1.04), OR = 1.01 (95% CI = 1.00–1.03) and OR = 1.04 (95% CI = 1.01–1.08), respectively. Conclusion: HLA-B27 positivity is the most relevant factor linked to AAU risk in SpA patients, and this association is even stronger in those patients with pSpA. Moreover, our study did not find an association between HLA-B27 positivity and recurrent AAU in SpA patients.
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Affiliation(s)
- Maria Llop
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), C/ Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain.,Medicine Department, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Mireia Moreno
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Marta Arévalo
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain
| | - Joan Calvet
- Rheumatology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí (I3PT), Sabadell, Spain.,Medicine Department, Universitat Autònoma de Barcelona, Sabadell, Spain
| | | | - Clementina López-Medina
- Rheumatology Department, Hôpital Cochin, Paris, France.,Rheumatology Department, Hospital Universitario Reina Sofía/IMIBIC/Universidad de Córdoba, Córdoba, Spain
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16
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Juanola X, Ramos MJM, Belzunegui JM, Fernández-Carballido C, Gratacós J. Treatment Failure in Axial Spondyloarthritis: Insights for a Standardized Definition. Adv Ther 2022; 39:1490-1501. [PMID: 35201604 PMCID: PMC8990961 DOI: 10.1007/s12325-022-02064-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/26/2022] [Indexed: 12/17/2022]
Abstract
Axial spondyloarthritis is a chronic inflammatory rheumatic disease that affects the axial skeleton and causes severe pain and disability. It may be also associated with extra-articular manifestations. Early diagnosis and appropriate treatment can reduce the severity of the disease and the risk of progression. The biological disease-modifying antirheumatic drugs (bDMARDs) tumor necrosis factor alpha (TNFα) inhibitors (TNFi) and the anti-interleukin (IL)-17A antibodies secukinumab and ixekizumab are effective agents to reduce disease activity and minimize the inflammation that damages the joints. New alternatives such as Janus kinase (JAK) inhibitors are also available. Unfortunately, response rates to bDMARDs are far from optimal, and many patients experience so-called treatment failure. The definition of treatment failure definition is often vague and may depend on the rigorousness of the therapeutic goal, the inclusion or not of peripheral symptoms/extra-articular manifestations, or patients' overall health. After an exhaustive bibliographic review, we propose a definition based on loss of the following status: low disease activity assessed by Ankylosing Spondylitis Disease Activity Score (ASDAS)-CRP, absence of extra-articular manifestations, and low disease impact on the patients' general health. Apart from discontinuing the therapy because of safety or intolerance reasons, two types of treatment failure can be differentiated depending on when it occurs: primary failure (no response within 6 months after treatment initiation, or lack of efficacy) and secondary failure (response within 6 months but lost thereafter, or loss of efficacy over time). Physicians should carefully consider the moment and the reason for the treatment failure to decide the next therapeutic step. In the case of primary failure on a first TNFi, it seems reasonable to switch to another class of drugs, i.e., an anti-IL-17 agent, as phase III trials showed that the response to IL-17 blockade was higher than to placebo in patients previously exposed to TNFi. When secondary failure occurs, and loss of efficacy is suspected to be caused by antidrug antibodies (ADAs), it is advisable to analyze serum TNFi and ADAs concentrations, if possible; in the presence of ADAs and low TNFi levels, changing the TNFi is rational as it may restore the TNFα blocking capacity. If ADAs are absent/low with adequate drug therapeutic levels, switching to another target might be the best strategy.
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Affiliation(s)
- Xavier Juanola
- Rheumatology Service, University Hospital Bellvitge, IDIBELL, Barcelona, Spain
| | | | | | | | - Jordi Gratacós
- Rheumatology Service, Medicine Department UAB, I3PT, University Hospital Parc Taulí Sabadell, Barcelona, Spain.
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17
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Llop M, Moreno M, Navarro-Compán V, Juanola X, de Miguel E, Almodóvar R, Quintana EC, Sanz JS, Beltrán E, Montesinos MDR, Calvet J, Berenguer-Llergo A, Gratacós J, Montejo PZ, Joven B, Almirall M, Espartero MCF, Gualda EB, Campos C, Estevez EC, Font P, Poch TC, Linares Ferrando LF, Lozano CR, Yoldi B. Sustained low disease activity measured by ASDAS slow radiographic spinal progression in axial spondyloarthritis patients treated with TNF-inhibitors: data from REGISPONSERBIO. Arthritis Res Ther 2022; 24:30. [PMID: 35063018 PMCID: PMC8780330 DOI: 10.1186/s13075-021-02695-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/08/2021] [Indexed: 12/30/2022] Open
Abstract
Abstract
Background
To evaluate the influence of the disease activity on radiographic progression in axial spondyloarthritis (axSpA) patients treated with TNF inhibitors (TNFi).
Methods
The study included 101 axSpA patients from the Spanish Register of Biological Therapy in Spondyloarthritides (REGISPONSERBIO), which had clinical data and radiographic assessment available. Patients were classified into 2 groups based on the duration of TNFi treatment at baseline: (i) long-term treatment (≥4 years) and (ii) no long-term treatment (< 4 years). Radiographs were scored by two readers according to the modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) with known chronology. Disease activity differences between patients’ groups at each time point were assessed using a linear mixed-effect model.
Results
Radiographic progression was defined as an increase in ≥2 mSASSS units. At inclusion, approximately half of the patients (45.5%) were receiving long-term treatment with TNFi (≥4 years). In this group of subjects, a significant difference in averaged Ankylosing Spondylitis disease Activity Score (ASDAS) across follow-up was found between progressors and non-progressors (2.33 vs 1.76, p=0.027, respectively). In patients not under long-term TNFi treatment (54.5%) though, no significant ASDAS differences were observed between progressors and non-progressors until the third year of follow-up. Furthermore, no significant differences were found in progression status, when disease activity was measured by Bath Ankylosing spondylitis Disease Activity Index (BASDAI) and C reactive protein (CRP).
Conclusions
Patients on long-term TNFi treatment with a mean sustained low disease activity measures by ASDAS presented lower radiographic progression than those with active disease.
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18
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Orellana C, Calvet J, Berenguer-Llergo A, Albiñana N, García Manrique M, Galisteo Lencastre C, Arévalo M, Llop M, Caixàs A, Gratacós J. Synovial Adiponectin Was More Associated with Clinical Severity than Synovial Leptin in Women with Knee Osteoarthritis. Cartilage 2021; 13:1675S-1683S. [PMID: 32079412 PMCID: PMC8808883 DOI: 10.1177/1947603520904776] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Different adipokines have been reported to play a role in the development, progression, and severity of knee osteoarthritis, but this association may be mediated by obesity. The aim of this study was to evaluate separately the associations of leptin and adiponectin with clinical severity and inflammatory markers in nonobese and obese women with knee osteoarthritis. DESIGN Cross-sectional study with systematic inclusion of 115 women with symptomatic primary knee osteoarthritis. Age, physical exercise, symptoms duration, and body mass index were collected. Radiographic severity was evaluated according to Kellgren-Lawrence scale. Pain and disability were assessed by WOMAC-total, -pain, -function subscales. Two adipokines (leptin and adiponectin) and 3 inflammatory markers (TNF-α, hsCRP, and IL-6) were measured by ELISA in synovial fluid and serum. RESULTS Synovial fluid adiponectin was associated with WOMAC pain, function, and total and with synovial fluid IL-6 in nonobese female knee osteoarthritis after controlling by confounders (partial correlation coefficient [PCC] = 0.395, 0.387, 0.427, and 0.649, respectively). Synovial fluid and serum leptin were significantly associated with IL-6 (PCC = 0.354) after controlling by confounders but associations with clinical severity and the rest of inflammatory markers were mitigated after control. CONCLUSIONS Adiponectin in synovial fluid was associated with clinical severity and local inflammatory markers in knee osteoarthritis women, while leptin relation was attenuated when controlled by confounders.
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Affiliation(s)
- Cristóbal Orellana
- Rheumatology Department, Parc Taulí
University Hospital, Sabadell, Barcelona, Spain
- I3PT Research Institute (UAB), Sabadell,
Catalunya, Spain
- Departament de Medicina, Universitat
Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Joan Calvet
- Rheumatology Department, Parc Taulí
University Hospital, Sabadell, Barcelona, Spain
- I3PT Research Institute (UAB), Sabadell,
Catalunya, Spain
- Departament de Medicina, Universitat
Autónoma de Barcelona (UAB), Barcelona, Spain
- Joan Calvet, Rheumatology Department, Parc
Taulí University Hospital, C/Parc Taulí S/n, Edifici VII Centenari, Sabadell,
Barcelona, 08208, Spain.
| | - Antoni Berenguer-Llergo
- Biostatistics and Bioinformatics Unit,
Institute for Research in Biomedicine, Barcelona, Spain
| | | | - María García Manrique
- Rheumatology Department, Parc Taulí
University Hospital, Sabadell, Barcelona, Spain
- I3PT Research Institute (UAB), Sabadell,
Catalunya, Spain
| | - Carlos Galisteo Lencastre
- Rheumatology Department, Parc Taulí
University Hospital, Sabadell, Barcelona, Spain
- I3PT Research Institute (UAB), Sabadell,
Catalunya, Spain
| | - Marta Arévalo
- Rheumatology Department, Parc Taulí
University Hospital, Sabadell, Barcelona, Spain
- I3PT Research Institute (UAB), Sabadell,
Catalunya, Spain
| | - María Llop
- Rheumatology Department, Parc Taulí
University Hospital, Sabadell, Barcelona, Spain
- I3PT Research Institute (UAB), Sabadell,
Catalunya, Spain
| | - Assumpta Caixàs
- I3PT Research Institute (UAB), Sabadell,
Catalunya, Spain
- Endocrinology and Nutrition Department,
Parc Taulí University Hospital, Sabadell, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí
University Hospital, Sabadell, Barcelona, Spain
- I3PT Research Institute (UAB), Sabadell,
Catalunya, Spain
- Departament de Medicina, Universitat
Autónoma de Barcelona (UAB), Barcelona, Spain
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19
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Garrido-Cumbrera M, Gratacós J, Collantes-Estevez E, Zarco-Montejo P, Sastre C, Christen L, Sanz-Gómez S, Correa-Fernández J, Navarro-Compán V. A Benchmarking Study Evaluating Axial Spondyloarthritis Burden in Spain and Other European Countries. Results from the Spanish Atlas and the European Map of Axial Spondyloarthritis (EMAS) Studies. Int J Rheum Dis 2021; 24:1127-1136. [PMID: 34268889 DOI: 10.1111/1756-185x.14173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 06/17/2021] [Accepted: 06/21/2021] [Indexed: 11/30/2022]
Abstract
AIM To compare the burden of disease in Spanish patients with axial spondyloarthritis (axSpA) vs other European countries (OEC). METHODS Data from 2846 unselected patients from the European Map of Axial Spondyloarthritis (EMAS) and the Atlas of Axial Spondyloarthritis in Spain (Atlas) were collected through online surveys. Comparative analysis was carried out between Spanish patients (2016) and patients from 12 OEC ( 2017-2018). Socio-demographic characteristics, life habits, and patient-reported outcomes (Bath Ankylosing Spondylitis Disease Activity Index 0-10, spinal stiffness 3-12, functional limitation 0-54, the 12-Item General Health Questionnaire [GHQ-12] for psychological distress 0-12) were compared. Chi-square and Mann-Whitney tests were used for qualitative and quantitative variables respectively. RESULTS 680 (23.9%) Spanish axSpA patients were compared to 2166 axSpA patients (76.1%) from OEC. Compared to Spain, the OEC group had a higher percentage of females (64.1% vs 52.5%; P < .001) and university-educated participants (51.7% vs 36.9%; P < .001). Spanish patients showed a greater diagnostic delay (8.5 ± 7.7 vs 7.2 ± 8.6 years; P < .001), visits to orthopedic specialists before diagnosis (56.9% vs 25.3%; P < .001), human leukocyte antigen-B27 carriership (77.1% vs 70.1%; P = .003), disease activity (5.7 ± 2.0 vs 5.4 ± 2.0; P = .024), and higher unemployment rates (21.7% vs 9.2%; P < .001). Despite lower rates of diagnosed anxiety and depression, Spanish patients were at higher risk of psychological distress according to the GHQ-12 (5.7 ± 4.5 vs 4.8 ± 4.0; P < .001). CONCLUSION Compared to European axSpA patients, Spanish patients experience a longer diagnostic delay and greater psychological distress. Being wrongly referred to orthopedic specialists and facing a more precarious labor scenario appear as possible causal factors, highlighting the need to increase the number of rheumatologists, the training of healthcare professionals, and improving axSpA patients' working conditions.
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Affiliation(s)
- Marco Garrido-Cumbrera
- Health & Territory Research, Universidad de Sevilla, Seville, Spain.,Spanish Federation of Spondyloarthritis Associations (CEADE), Madrid, Spain
| | | | - Eduardo Collantes-Estevez
- Reina Sofia University Hospital, Cordova, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), Universidad de Córdoba, Cordova, Spain
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20
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Merino M, Braçe O, González-Domínguez A, Hidalgo-Vega Á, Garrido-Cumbrera M, Gratacós J. Social economic costs of ankylosing spondylitis in Spain. Clin Exp Rheumatol 2021. [DOI: 10.55563/clinexprheumatol/lycdc8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Olta Braçe
- Health & Territory Research (HTR), Universidad de Sevilla, Spain
| | | | - Álvaro Hidalgo-Vega
- Universidad de Castilla-La Mancha, Toledo, and Fundación Weber, Madrid, Spain
| | - Marco Garrido-Cumbrera
- Health & Territory Research (HTR), Universidad de Sevilla, and Spanish Federation of Spondyloarthritis Associations (CEADE), Fuenlabrada, Spain
| | - Jordi Gratacós
- Rheumatology Department, University Hospital Parc Taulí, 13PT Research Institute (UAB), Sabadell, Barcelona; Medicine Department (UAB), Barcelona, Spain
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21
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Moreno M, Arévalo M, Zamora M, Pontes C, Oliva JC, Gratacós J. Comparison of disease activity in patients with ankylosing spondylitis under TNFi or NSAID treatment, is there any difference? An observational study. Reumatol Clin (Engl Ed) 2021; 17:192-196. [PMID: 31558361 DOI: 10.1016/j.reuma.2019.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 07/11/2019] [Accepted: 07/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To assess whether there are any real-life differences between ankylosing spondylitis (AS) patients treated with NSAID or TNF inhibitors (TNFi) regarding disease activity. METHODS This is an observational transversal unicentric study with retrospective retrieval of data from clinical records of all AS patients attended in our hospital. We compared clinical activity measured by Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) scores between patients treated with NSAID and those treated with TNFi, in terms of low disease activity defined as BASDAI<4, and inactivity when BASDAI≤2. As secondary variables, we also collected epidemiological, clinical and radiological data from all those patients. RESULTS A total of 152 AS patients (81% male), with an average age of 49.45±12.38 years and a disease duration of 13.5±9.79 years were included in the study. Eighty-nine patients (58.6%) were treated with NSAID and 63 (41.4%) with TNFi. The proportion of patients with low disease activity and inactive disease was significantly higher in the TNFi treatment group compared to the NSAID group (81 vs. 47, P=.0001) and (44 vs. 24, P=.007), respectively. Patients treated with NSAIDs also showed significantly more global pain and night pain than those under TNFi therapy. The BASFI score and especially the type of treatment (NSAID or TNFI) were the only variables independently associated with low disease activity or inactive disease. CONCLUSION In real world practice, AS patients under TNFi treatment show a better control of clinical symptoms than those under NSAIDs.
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Affiliation(s)
- Mireia Moreno
- Rheumatology Department, University Hospital Parc Taulí, I3PT Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Marta Arévalo
- Rheumatology Department, University Hospital Parc Taulí, I3PT Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain.
| | - Marc Zamora
- Universitat Autònoma de Barcelona (UAB), Spain
| | - Caridad Pontes
- Clinical Pharmacology Unit, Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Juan Carlos Oliva
- Statistics Department, University Hospital Parc Taulí, I3PT Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
| | - Jordi Gratacós
- Rheumatology Department, University Hospital Parc Taulí, I3PT Universitat Autònoma de Barcelona, Sabadell (Barcelona), Spain
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22
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Gratacós J, Behrens F, Coates LC, Lubrano E, Thaçi D, Bundy C, de la Torre-Aboki J, Luelmo J, Voorneveld H, Richette P. A 12-point recommendation framework to support advancement of the multidisciplinary care of psoriatic arthritis: A call to action. Joint Bone Spine 2021; 88:105175. [PMID: 33771760 DOI: 10.1016/j.jbspin.2021.105175] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 02/22/2021] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Making a differential diagnosis of psoriatic arthritis (PsA) is not straightforward. This is partly because of its heterogeneous presentation and partly because many patients with PsA are initially diagnosed with psoriasis and treated in primary care or by dermatologists, with referral to rheumatologists being delayed. Once diagnosed, optimal disease control requires frequent specialist monitoring, adjustment or switching of therapies, and management of comorbidities and concomitant diseases, as well as attention to patients' overall well-being. Given the breadth of expertise that diagnosis and management of PsA requires, we sought to define a collaborative, structured framework that supports the optimisation of multidisciplinary care for patients with PsA in Europe. METHODS An expert panel comprising four rheumatologists, three dermatologists, two specialist nurses and one psychologist-from Spain, the United Kingdom, The Netherlands, Germany, France and Italy-met face-to-face to take part in a modified Delphi exercise. RESULTS The result of this exercise is a set of recommendations that are based on combining published evidence with the panel's extensive clinical experience. Recommendations can be implemented in a number of ways, but the central call-to-action of this framework is the need for improved collaboration between dermatologists (or primary care physicians) and rheumatologists. This could occur in a variety of different formats: standard referral pathways, multidisciplinary physician meetings to discuss patient cases, or 'one stop', combined clinics. CONCLUSION We anticipate that when the majority of patients with PsA receive regular multidisciplinary care, improved patient outcomes will follow, although robust research is needed to explore this assumption.
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Affiliation(s)
- Jordi Gratacós
- Rheumatology Department, Hospital Universitario Parc Taulí de Sabadell, I3PT, UAB, Parc Taulí, 1 Sabadell, Barcelona, Spain
| | - Frank Behrens
- CIRI/Rheumatologie und Fraunhofer IME-Translationale Medizin und Pharmakologie, Goethe-Universität, Frankfurt am Main, Germany
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, Windmill Road, Oxford, UK
| | - Ennio Lubrano
- Academic Rheumatology Unit, Dipartimento di Medicina e Scienze della Salute "Vincenzo Tiberio", Università degli Studi del Molise, Campobasso, Italy
| | - Diamant Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Christine Bundy
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Jesus Luelmo
- Department of Dermatology, Hospital of Sabadell, Corporació Sanitària Parc Taulí, Autonomous University of Barcelona, Barcelona, Spain
| | | | - Pascal Richette
- Service de Rhumatologie, Hôpital Lariboisiere Centre Viggo Petersen, Université de Paris, 2, Rue Ambroise-Pare, 75010 Paris, France; Inserm UMR1132 Bioscar, Universite Paris Diderot UFR de Medecine, Paris, France.
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23
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Urruticoechea-Arana A, Benavent D, León F, Almodovar R, Belinchón I, de la Cueva P, Fernández-Carballido C, Loza E, Gratacós J. Psoriatic arthritis screening: A systematic literature review and experts' recommendations. PLoS One 2021; 16:e0248571. [PMID: 33720981 PMCID: PMC7959352 DOI: 10.1371/journal.pone.0248571] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/01/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To analyze the performance of psoriatic arthritis (PsA) screening tools, examine their implementation in daily practice, and reach a consensus about the best screening tool for implementation in daily practice in different medical settings. METHODS A systematic literature review (SLR), structured telephone interviews to hospitals, and a multidisciplinary nominal group meeting were all conducted. The SLR employed sensitive search strategies using Medline, Embase, and the Cochrane Library up to January 2020. Two reviewers independently selected articles that reported data on PsA screening tools and that included sufficient data to at least calculate the sensitivity and specificity of those tools (e.g., questionnaires, algorithms, specific questions, and biomarkers). The hospital interviews collected data regarding the process of suspected PsA diagnosis and referral to rheumatology, the implementation of PsA screening tools, and barriers and facilitators to implementation of those tools. In the nominal group meeting, a multidisciplinary team of experts discussed all these data and subsequently recommended a screening tool for implementation. RESULTS The SLR included 41 moderate-quality studies that analyzed 14 PsA screening tools, most of which were questionnaire-based tools. All of these studies reported a moderate-good performance but presented different characteristics regarding the time to completion or the number and type of items or questions. The implementation of screening tools was low (30.5%). The experts ultimately recommended regular use of a PsA screening tool, preferably the PURE-4 questionnaire. CONCLUSIONS The implementation of PsA screening tools like the PURE-4 questionnaire in daily practice likely improves the prognosis of PsA patients.
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Affiliation(s)
| | - Diego Benavent
- Rheumatology Department, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Fernando León
- Primary Care, San Juan de la Cruz Health Center, Pozuelo de Alarcón, Madrid, Spain
| | - Raquel Almodovar
- Rheumatology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Isabel Belinchón
- Department of Dermatology, Hospital General Universitario de Alicante-ISABIAL-UMH, Alicante, Spain
| | - Pablo de la Cueva
- Dermatology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Estíbaliz Loza
- Instituto de Salud Musculoesquelética, InMusc, Madrid, Spain
| | - Jordi Gratacós
- Rheumatology Department, Hospital Universitari Parc Taulí, Sabadell, Spain
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Garcia-Cirera S, Calvet J, Martin-Marimon JC, García-Chamón RB, Gratacós J. PET-CT SCAN TO DIAGNOSE AND DEMONSTRATE RESOLUTION OF LUPUS LYMPHADENITIS WITH BELIMUMAB. Rheumatology (Oxford) 2021; 60:e324-e325. [PMID: 33693531 DOI: 10.1093/rheumatology/keab226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 02/23/2021] [Indexed: 11/12/2022] Open
Affiliation(s)
- S Garcia-Cirera
- Rheumatology Department, Parc Taulí University Hospital, I3PT Research Institute (UAB), Sabadell, Spain
| | - J Calvet
- Rheumatology Department, Parc Taulí University Hospital, I3PT Research Institute (UAB), Sabadell, Spain
| | | | - R B García-Chamón
- Anatomic Pathology Department, Parc Taulí University Hospital, I3PT Research Institute (UAB), Sabadell, Spain
| | - J Gratacós
- Rheumatology Department, Parc Taulí University Hospital, I3PT Research Institute (UAB), Sabadell, Spain
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Calvet X, Carpio D, Rodríguez-Lago I, García-Vicuña R, Barreiro-de-Acosta M, Juanola X, Aguas M, Castillo C, Gratacós J. Risk of infection associated with Janus Kinase (JAK) inhibitors and biological therapies in inflammatory intestinal disease and rheumatoid arthritis. Prevention strategies. Gastroenterol Hepatol 2021; 44:587-598. [PMID: 33640469 DOI: 10.1016/j.gastrohep.2021.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/23/2020] [Accepted: 01/10/2021] [Indexed: 02/07/2023]
Abstract
Patients with certain immune-mediated inflammatory diseases, such as rheumatoid arthritis (RA) and inflammatory bowel disease (IBD), have an increased risk of severe infectious diseases than the general population, which are mainly associated with the immunosuppressive treatments that they receive. These treatments act on the immune system through different mechanisms, causing different degrees of immunosuppression and a variable risk depending on whether the pathogen is a virus, bacteria or fungus. This article reviews the most relevant literature on the subject, which was selected and discussed by a panel of experts. The aim of this article is to review the risk of infections in patients with IBD and RA, and the potential preventive measures.
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Affiliation(s)
- Xavier Calvet
- Servicio del Aparato Digestivo, Hospital Universitario Parc Taulí, Departamento de Medicina, Universidad Autónoma de Barcelona, CIBERehd, Instituto de Salud Carlos III. Parc Taulí, Sabadell, Barcelona, España.
| | - Daniel Carpio
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Complexo Hospitalario Universitario de Pontevedra, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Pontevedra, España
| | - Iago Rodríguez-Lago
- Servicio de Aparato Digestivo, Hospital de Galdakao-Usansolo, Instituto de Investigación Sanitaria Biocruces Bizkaia, Galdakao, Bizkaia, España
| | - Rosario García-Vicuña
- Servicio de Reumatología, Hospital Universitario de la Princesa, IIS-IP, Madrid, España
| | - Manuel Barreiro-de-Acosta
- Unidad de Enfermedad Inflamatoria Intestinal, Servicio de Aparato Digestivo, Hospital Clínico Universitario, Santiago de Compostela, A Coruña, España
| | - Xavier Juanola
- Servicio de Reumatología, Hospital Universitario de Bellvitge, Universidad de Barcelona, IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Mariam Aguas
- Departamento de Gastroenterología, Servicio de Medicina Digestiva, Hospital Universitario y Politécnico, CIBERehd, Valencia, España
| | - Concepción Castillo
- Sección de Reumatología, Hospital Universitario Torrecárdenas, Almería, España
| | - Jordi Gratacós
- Servicio de Reumatología, Hospital Universitario Parc Taulí, Departamento de Medicina, Universidad Autónoma de Barcelona, Sabadell, Barcelona, España
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26
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Orbai AM, Gratacós J, Turkiewicz A, Hall S, Dokoupilova E, Combe B, Nash P, Gallo G, Bertram CC, Gellett AM, Sprabery AT, Birt J, Macpherson L, Geneus VJ, Constantin A. Efficacy and Safety of Ixekizumab in Patients with Psoriatic Arthritis and Inadequate Response to TNF Inhibitors: 3-Year Follow-Up (SPIRIT-P2). Rheumatol Ther 2020; 8:199-217. [PMID: 33278016 PMCID: PMC7991062 DOI: 10.1007/s40744-020-00261-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 11/16/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose Ixekizumab is a high-affinity monoclonal antibody that selectively targets interleukin-17A. The objective of this study was to assess the long-term efficacy and safety (to week 156) of ixekizumab in patients with active psoriatic arthritis and inadequate response or intolerance to one or two tumor necrosis factor inhibitors. Methods In the SPIRIT-P2 study (ClinicalTrials.gov ID: NCT02349295), patients were randomized to placebo or ixekizumab 80 mg every 4 weeks (IXE Q4W) or every 2 weeks (IXE Q2W) following a 160-mg starting dose. During the extension period (weeks 24–156), patients maintained their original ixekizumab dose, and placebo patients received IXE Q4W or IXE Q2W (1:1). Exposure-adjusted incidence rates (IRs) per 100 patient-years (PY) are presented. Results Of 363 patients enrolled in the study, 310 entered the extension period. In all patients treated with IXE Q4W and IXE Q2W at week 0, responses persisted to week 156. At week 156, clinical responses (observed) in patients treated with IXE Q4W and IXE Q2W were assessed [American College of Rheumatology (ACR) response criteria and minimal disease activity (MDA) criteria]: 84 and 85% showed 20% improvement (ACR20); 60 and 58% showed 50% improvement (ACR50); 35 and 47% showed 70% improvement (ACR70), respectively; and 48 and 54% showed MDA. Placebo patients re-randomized to ixekizumab also demonstrated sustained efficacy, as measured by ACR and MDA responses. In the All Ixekizumab Exposure Safety Population (n = 337), with 644 PY of ixekizumab exposure, treatment-emergent adverse events (TEAEs) were reported by 286 patients (44.4 IR). The most common TEAEs were upper respiratory tract infection (9.80 IR), nasopharyngitis (8.2 IR), sinusitis (6.2 IR), and bronchitis (4.5 IR). Serious adverse events were reported by 42 (6.5 IR) patients (included 3 deaths and 10 infections). Conclusion In this 156-week study of ixekizumab, improvements in signs and symptoms of psoriatic arthritis and the safety profile remained consistent with those in previous reports. Trial registration ClinicalTrials.gov identifier: NCT02349295. Electronic supplementary material The online version of this article (10.1007/s40744-020-00261-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ana-Maria Orbai
- Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Jordi Gratacós
- Rheumatology Department, Hospital Universitari Parc Taulí, Sabadell, Barcelona, Spain.,Medicine Department, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | | | | | - Eva Dokoupilova
- Medical Plus, s.r.o., Uherské Hradiště, Czech Republic.,Department of Pharmaceutical Technology, Faculty of Pharmacy, Masaryk University, Brno, Czech Republic
| | - Bernard Combe
- CHU Montpellier and Montpellier University, Montpellier, France
| | - Peter Nash
- School of Medicine, Griffith University, Brisbane, Australia
| | - Gaia Gallo
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | | | - Julie Birt
- Eli Lilly and Company, Indianapolis, IN, USA
| | | | | | - Arnaud Constantin
- Hospital Pierre-Paul Riquet and Université Toulouse III, Toulouse, France
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Calvet J, Gratacós J, Amengual MJ, Llop M, Navarro M, Moreno A, Berenguer-Llergo A, Serrano A, Orellana C, Cervantes M. CD4 and CD8 Lymphocyte Counts as Surrogate Early Markers for Progression in SARS-CoV-2 Pneumonia: A Prospective Study. Viruses 2020; 12:E1277. [PMID: 33182268 PMCID: PMC7695272 DOI: 10.3390/v12111277] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND COVID-19 pathophysiology and the predictive factors involved are not fully understood, but lymphocytes dysregulation appears to play a role. This paper aims to evaluate lymphocyte subsets in the pathophysiology of COVID-19 and as predictive factors for severe disease. PATIENT AND METHODS A prospective cohort study of patients with SARS-CoV-2 bilateral pneumonia recruited at hospital admission. Demographics, medical history, and data regarding SARS-CoV-2 infection were recorded. Patients systematically underwent complete laboratory tests, including parameters related to COVID-19 as well as lymphocyte subsets study at the time of admission. Severe disease criteria were established at admission, and patients were classified on remote follow-up according to disease evolution. Linear regression models were used to assess associations with disease evolution, and Receiver Operating Characteristic (ROC) and the corresponding Area Under the Curve (AUC) were used to evaluate predictive values. RESULTS Patients with critical COVID-19 showed a decrease in CD3+CD4+ T cells count compared to non-critical (278 (485 IQR) vs. 545 (322 IQR)), a decrease in median CD4+/CD8+ ratio (1.7, (1.7 IQR) vs. 3.1 (2.4 IQR)), and a decrease in median CD4+MFI (21,820 (4491 IQR) vs. 26,259 (3256 IQR)), which persisted after adjustment. CD3+CD8+ T cells count had a high correlation with time to hospital discharge (PC = -0.700 (-0.931, -0.066)). ROC curves for predictive value showed lymphocyte subsets achieving the best performances, specifically CD3+CD4+ T cells (AUC = 0.756), CD4+/CD8+ ratio (AUC = 0.767), and CD4+MFI (AUC = 0.848). CONCLUSIONS A predictive value and treatment considerations for lymphocyte subsets are suggested, especially for CD3CD4+ T cells. Lymphocyte subsets determination at hospital admission is recommended.
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Affiliation(s)
- Joan Calvet
- Rheumatology Department, Parc Taulí University Hospital, I3PT Research Institute (UAB), Universitat Autónoma de Barcelona (UAB), 08208 Sabadell, Spain; (J.C.); (M.L.); (C.O.)
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí University Hospital, I3PT Research Institute (UAB), Universitat Autónoma de Barcelona (UAB), 08208 Sabadell, Spain; (J.C.); (M.L.); (C.O.)
| | - María José Amengual
- Immunology Unit UDIAT, Parc Taulí University Hospital. I3PT Research Institute (UAB), 08208 Sabadell, Spain;
| | - Maria Llop
- Rheumatology Department, Parc Taulí University Hospital, I3PT Research Institute (UAB), Universitat Autónoma de Barcelona (UAB), 08208 Sabadell, Spain; (J.C.); (M.L.); (C.O.)
| | - Marta Navarro
- Infectious Disease Department, Parc Taulí University Hospital. I3PT Research Institute (UAB), 08208 Sabadell, Spain; (M.N.); (M.C.)
| | - Amàlia Moreno
- Pneumology Department, Parc Taulí University Hospital, I3PT Research Institute (UAB), 08208 Sabadell, Spain;
| | - Antoni Berenguer-Llergo
- Biostatistics and Bioinformatics Unit, Institute for Research in Biomedicine Barcelona (IRB Barcelona), 08028 Barcelona, Spain;
| | - Alejandra Serrano
- Research Biology Unit, I3PT Research Institute (UAB), 08208 Sabadell, Spain;
| | - Cristóbal Orellana
- Rheumatology Department, Parc Taulí University Hospital, I3PT Research Institute (UAB), Universitat Autónoma de Barcelona (UAB), 08208 Sabadell, Spain; (J.C.); (M.L.); (C.O.)
| | - Manel Cervantes
- Infectious Disease Department, Parc Taulí University Hospital. I3PT Research Institute (UAB), 08208 Sabadell, Spain; (M.N.); (M.C.)
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Merola JF, Papp KA, Nash P, Gratacós J, Boehncke WH, Thaçi D, Graham D, Hsu MA, Wang C, Wu J, Young P. Tofacitinib in psoriatic arthritis patients: skin signs and symptoms and health-related quality of life from two randomized phase 3 studies. J Eur Acad Dermatol Venereol 2020; 34:2809-2820. [PMID: 32271970 PMCID: PMC7818414 DOI: 10.1111/jdv.16433] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/28/2020] [Accepted: 03/16/2020] [Indexed: 12/14/2022]
Abstract
Background Psoriatic arthritis (PsA) is a chronic, systemic immune‐mediated inflammatory musculoskeletal disease. The onset of dermatologic symptoms often precedes rheumatic manifestations. Tofacitinib is an oral Janus kinase inhibitor for the treatment of PsA that has been shown to improve dermatologic symptoms in patients with PsA. Objectives To investigate the efficacy of tofacitinib in improving dermatologic endpoints in adult patients with active PsA. Methods This analysis included data from two placebo‐controlled, double‐blind, phase 3 studies in patients with active PsA and an inadequate response (IR) to ≥1 conventional synthetic disease‐modifying antirheumatic drug (csDMARD) who were tumor necrosis factor inhibitor (TNFi)‐naïve (OPAL Broaden; NCT01877668) or an IR to ≥1 TNFi (OPAL Beyond; NCT01882439). Patients had active plaque psoriasis at screening and received a stable dose of one csDMARD during the study. Patients were randomized to tofacitinib 5 mg twice daily (BID), 10 mg BID, adalimumab 40 mg subcutaneous injection once every 2 weeks (OPAL Broaden only) or placebo (to Month 3). Dermatologic endpoints: Psoriasis Area and Severity Index (PASI) total score; PASI90 overall; PASI75 and PASI90 by baseline PASI severity; Physician’s Global Assessment of Psoriasis; Nail Psoriasis Severity Index; Dermatology Life Quality Index total and sub‐dimension scores; Itch Severity Item; and Patient’s Global Joint and Skin Assessment‐Visual Analog Scale‐Psoriasis question. Results In patients with active PsA, including those stratified by mild or moderate/severe dermatologic symptoms, greater improvements from baseline and percentage of responders were observed in tofacitinib‐treated patients vs. placebo for the majority of analyzed dermatologic endpoints at Months 1 and 3, and improvements were maintained to Month 12 in OPAL Broaden and Month 6 in OPAL Beyond. Similar effects were observed in adalimumab‐treated patients vs. placebo in OPAL Broaden across dermatologic endpoints. Conclusions Tofacitinib provides a treatment option for patients with active PsA, including the burdensome dermatologic symptoms of PsA.
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Affiliation(s)
- J F Merola
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - K A Papp
- Probity Medical Research and K Papp Clinical Research Inc, Waterloo, ON, Canada
| | - P Nash
- Department of Medicine, Griffith University, Brisbane, QLD, Australia
| | - J Gratacós
- Servicio de Reumatología, Hospital Universitari Parc Taulí Sabadell, Barcelona, Spain
| | - W H Boehncke
- Division of Dermatology and Venereology, Geneva University Hospitals, Geneva, Switzerland.,Department of Pathology and Immunology, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - D Thaçi
- Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | | | | | - C Wang
- Pfizer Inc, Groton, CT, USA
| | - J Wu
- Pfizer Inc, Groton, CT, USA
| | - P Young
- Pfizer Inc, Collegeville, PA, USA
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Smolen JS, Mease P, Tahir H, Schulze-Koops H, de la Torre I, Li L, Hojnik M, Sapin C, Okada M, Caporali R, Gratacós J, Goupille P, Liu Leage S, Pillai S, Nash P. Multicentre, randomised, open-label, parallel-group study evaluating the efficacy and safety of ixekizumab versus adalimumab in patients with psoriatic arthritis naïve to biological disease-modifying antirheumatic drug: final results by week 52. Ann Rheum Dis 2020; 79:1310-1319. [PMID: 32660977 PMCID: PMC7509529 DOI: 10.1136/annrheumdis-2020-217372] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/05/2020] [Accepted: 06/09/2020] [Indexed: 01/02/2023]
Abstract
Objectives SPIRIT head-to-head (H2H) is a 52-week (Wk) trial comparing ixekizumab (IXE) with adalimumab (ADA) for simultaneous American College of Rheumatology (ACR)50 and Psoriasis Area and Severity Index (PASI)100 responses in 566 patients (distributed evenly across both groups) with psoriatic arthritis (PsA). IXE was superior to ADA for this primary end point at Wk24. We aimed to determine the final efficacy and safety results through Wk52 including a prespecified subgroup analysis of concomitant conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD) use. Methods SPIRIT-H2H is a Wk52 multicentre, open-label, blinded-assessor study comparing IXE and ADA in bionaïve patients with PsA. Patients were randomised 1:1 to IXE or ADA with stratification by concomitant csDMARD use and presence of moderate-to-severe plaque psoriasis. Prespecified end points at Wk24 and Wk52 included musculoskeletal, psoriasis, quality-of life outcomes, subgroup analyses and safety. Results A significantly higher proportion of patients treated with IXE versus ADA simultaneously achieved ACR50 and PASI100 (39% vs 26%, p<0.001), PASI100 (64% vs 41%, p<0.001) at Wk52. Efficacy of IXE and ADA was similar at Wk52 for ACR50 (49.8% vs 49.8%, p=0.924), treat-to-target outcomes, enthesitis and dactylitis resolution. Responses to IXE were consistent irrespective of concomitant csDMARD use. Significantly more patients on IXE monotherapy versus ADA monotherapy had simultaneous ACR50 and PASI100 (38% vs 19%, p=0.007), and PASI100 responses (66% vs 35%, p<0.001) at Wk52. There were no new safety findings for IXE or ADA. Conclusions IXE provided significantly greater simultaneous joint and skin improvement than ADA through Wk52 in bionaïve patients with PsA. IXE showed better efficacy on psoriasis and performed at least as well as ADA on musculoskeletal manifestations. IXE efficacy was consistent irrespective of concomitant csDMARD use. Trial registration number NCT03151551.
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Affiliation(s)
- Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Philip Mease
- Providence St Joseph Health, Rentton, Washington, USA.,Swedish Medical Center, Seattle, Washington, USA
| | - Hasan Tahir
- Royal Free London NHS Foundation Trust, London, UK
| | - Hendrik Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, Ludwig Maximilians University Munich, Munich, Germany
| | | | - Lingnan Li
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Maja Hojnik
- Eli Lilly and Company, Indianapolis, Indiana, USA
| | | | - Masato Okada
- Immuno-Rheumatology Center, St. Luke's International Hospital, Tokyo, Japan
| | - Roberto Caporali
- Department of Clinical Sciences and Community Health, University of Milan, G. Pini Hospital, Milan, Lombardia, Italy
| | - Jordi Gratacós
- Rheumatology Department, Hospital Universitario Parc Taulí, Barcelona, Spain
| | - Philippe Goupille
- Department of Rheumatology, Regional University Hospital Centre Tours, Tours, Centre, France
| | | | | | - Peter Nash
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
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Garrido-Cumbrera M, Chacón-García J, Navarro-Compán V, Gratacós J, Sanz-Gómez S, Collantes-Estevez E. Does Belonging to a Patient Association Is of Help for Patients with Axial Spondyloarthritis? Results from the Atlas Survey. Curr Rheumatol Rep 2020; 22:22. [PMID: 32410101 DOI: 10.1007/s11926-020-00897-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW International guidelines for axial spondyloarthritis (axSpA) suggest that patients benefit from becoming members of patient associations. However, the scientific evidence for this is limited and unconvincing. The objective of this study was to evaluate the differences in sociodemographic characteristics, lifestyle habits, and patient-reported outcomes (PROs) between axSpA patients belonging to patient associations versus those who do not. RECENT FINDINGS Out of 680 patients, 301 (44.3%) were members of a patient association. A significant proportion of association members were found to engage in physical activities considered appropriate to their condition (48.2% vs. 39.8%, p = 0.03), and smoked significantly less compared with their non-association counterparts (22.7% vs. 33.6%, p = 0.02). In addition, despite having longer disease duration, and receiving similar treatments, members of associations reported significantly lower disease activity (BASDAI 5.1 vs. 5.8; p < 0.001), less functional limitations (Functional Limitation Index 26.4 vs. 28.6; p < 0.05), and a lower risk of psychological distress (GHQ-12 4.9 vs. 6.5; p < 0.001). The results of this study suggest there are beneficial effects of belonging to a patient association for managing axSpA, since those member patients experience better lifestyle habits and PROs than those who do not so participate. Rheumatologists should encourage patients to enroll in patient associations for a holistic approach to managing their condition.
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Affiliation(s)
- Marco Garrido-Cumbrera
- Universidad de Sevilla, Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasant Investigación, Tecnología e Innovación Manuel Losada Villasante, C/ Doctor Rafael Martínez Domínguez s/n, Seville, 41013, Spain. .,Spanish Federation of Spondyloarthritis Associations (CEADE), Madrid, Spain.
| | - Jorge Chacón-García
- Universidad de Sevilla, Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasant Investigación, Tecnología e Innovación Manuel Losada Villasante, C/ Doctor Rafael Martínez Domínguez s/n, Seville, 41013, Spain
| | | | - Jordi Gratacós
- Department of Rheumatology, Hospital Universitari Parc Taulí, I3PT, UAB, Sabadell, Spain
| | - Sergio Sanz-Gómez
- Universidad de Sevilla, Health & Territory Research (HTR), Centro de Investigación, Tecnología e Innovación Manuel Losada Villasant Investigación, Tecnología e Innovación Manuel Losada Villasante, C/ Doctor Rafael Martínez Domínguez s/n, Seville, 41013, Spain
| | - Eduardo Collantes-Estevez
- Department of Rheumatology, Reina Sofia University Hospital, Córdoba, Spain.,Maimonides Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba, Córdoba, Spain
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Sanz Sanz J, Beltrán E, Díaz-Miguel Pérez MC, Fernández-Carballido C, Galíndez E, García Porrua C, Gratacós J, Medina J, Queiro R, Ramírez J, Reina D, Rodríguez Lozano C, Rodríguez Martínez FJ, Rubio E, Veroz R. Norma de calidad para el manejo del paciente con artritis psoriásica: proyecto QUANTUM. ACTA ACUST UNITED AC 2020; 16:203-215. [DOI: 10.1016/j.reuma.2018.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/12/2018] [Accepted: 06/26/2018] [Indexed: 12/27/2022]
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Queiro R, Coto P, Joven B, Rivera R, Navío Marco T, de la Cueva P, Alvarez Vega JL, Narváez Moreno B, Rodriguez Martínez FJ, Pardo Sánchez J, Feced Olmos C, Pujol C, Rodríguez J, Notario J, Pujol Busquets M, García Font M, Galindez E, Pérez Barrio S, Urruticoechea-Arana A, Hergueta M, López Montilla MD, Vélez García-Nieto A, Maceiras F, Rodríguez Pazos L, Rubio Romero E, Rodríguez Fernandez Freire L, Luelmo J, Gratacós J. Estado actual de la atención multidisciplinar para pacientes con artritis psoriásica en España: proyecto NEXUS 2.0. ACTA ACUST UNITED AC 2020; 16:24-31. [DOI: 10.1016/j.reuma.2018.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 01/15/2018] [Accepted: 01/17/2018] [Indexed: 12/13/2022]
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Gratacós J, Galíndez E, Otón T. Is obesity a predictor for lack of response to treatment in psoriatic arthritis? A systematic review. ACTA ACUST UNITED AC 2019; 17:268-278. [PMID: 31708450 DOI: 10.1016/j.reuma.2019.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 04/23/2019] [Accepted: 06/05/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES To update the study of the association between obesity and treatment response in psoriatic arthritis. METHODS Updating a systematic review of clinical trials, prospective or retrospective longitudinal studies and case-control studies in psoriatic arthritis in which obesity was assessed as a predictor of efficacy or toxicity. Risks of bias were assessed with validated scales. A meta-analysis of the results of studies with similar outcome variables and weight measurements was performed. RESULTS Twenty-one studies were included (6 review of clinical trials, 6 longitudinal studies, 7 registers and one case-control studie), with moderate quality. The risk of achieving an ACR20 response if weight≥100kg was estimated at OR=1.42 (1-2.08) and that of withdrawing treatment in an OR of 1.60 (95% CI: 1.34 - 1.92). CONCLUSIONS There seems to be a greater risk of withdrawal of treatment due to inefficacy and difficulty in achieving remission in patients with psoriatic arthritis if they are obese.
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Affiliation(s)
- Jordi Gratacós
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell (Barcelona), España
| | - Eva Galíndez
- Servicio de Reumatología, Hospital Universitario Basurto, Bilbao, Vizcaya, España
| | - Teresa Otón
- Instituto de Salud Musculoesquelética, Madrid, España.
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Moreno M, Gratacós J, Torrente-Segarra V, Sanmarti R, Morlà R, Pontes C, Llop M, Juanola X. Withdrawal of infliximab therapy in ankylosing spondylitis in persistent clinical remission, results from the REMINEA study. Arthritis Res Ther 2019; 21:88. [PMID: 30953541 PMCID: PMC6451276 DOI: 10.1186/s13075-019-1873-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/22/2019] [Indexed: 12/16/2022] Open
Abstract
Background Recent data suggest that anti-TNF doses can be reduced in ankylosing spondylitis (AS) patients. Some authors even propose withdrawing treatment in patients in clinical remission; however, at present there is no evidence to support this. Objective To assess how long AS patients with persistent clinical remission remained free of flares after anti-TNF withdrawal and to evaluate the effects of treatment reintroduction. We also analyze the characteristics of patients who did not present clinical relapse. Methods Multicenter, prospective, observational study of a cohort of patients with active AS who had received infliximab as a first anti-TNF treatment and who presented persistent remission (more than 6 months). We recorded at baseline and every 6–8 weeks over the 12-month period the age, gender, disease duration, peripheral arthritis or enthesitis, HLA-B27 status, BASDAI, CRP, ESR, BASFI, and three visual analogue scales, spine global pain, spinal night time pain, and patient’s global assessment. Results Thirty-six out of 107 patients (34%) presented persistent remission and were included in our study. After treatment withdrawal, 21 of these 36 patients (58%) presented clinical relapse during follow-up. Infliximab therapy was reintroduced and only 52% achieved clinical remission, as they had before the discontinuation of infliximab; in an additional 10%, reintroduction of infliximab was ineffective, obliging us to change the anti-TNF therapy. No clinical or biological factors were associated with the occurrence of relapse during the follow-up. Conclusions Two thirds of patients in clinical remission presented clinical relapse shortly after infliximab withdrawal. Although the reintroduction of infliximab treatment was safe, half of the patients did not present the same clinical response that they had achieved prior to treatment withdrawal.
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Affiliation(s)
- Mireia Moreno
- Rheumatology Department, Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, 08208, Sabadell, Barcelona, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, 08208, Sabadell, Barcelona, Spain.
| | | | - Raimon Sanmarti
- Rheumatology Department, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain
| | - Rosa Morlà
- Rheumatology Department, Hospital del Vendrell, Tarragona, Spain
| | - Caridad Pontes
- Clinical Pharmacology Department, ParcTaulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Maria Llop
- Rheumatology Department, Parc Taulí Hospital Universitari, I3PT, Universitat Autònoma de Barcelona, 08208, Sabadell, Barcelona, Spain
| | - Xavier Juanola
- Rheumatology Department, Hospital Universitari de Bellvitge, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Orellana C, Moreno M, Calvet J, Navarro N, García-Manrique M, Gratacós J. Ultrasound Findings in Patients With Femoracetabular Impingement Without Radiographic Osteoarthritis: A Pilot Study. J Ultrasound Med 2019; 38:895-901. [PMID: 30203593 DOI: 10.1002/jum.14768] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 05/28/2018] [Accepted: 06/29/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To assess ultrasound (US) abnormalities in patients with clinical and radiographic features of femoracetabular impingement (FAI) without radiologic osteoarthritis. METHODS This study included patients aged 50 years or younger with hip pain and clinical and radiographic signs suggestive of FAI but without radiographic hip osteoarthritis. Demographic characteristics, the symptom duration, and the radiologic type of FAI were recorded. Ultrasound examinations assessed for anterior labral abnormalities, osteophytes, bone cortex irregularities, capsular distension, and acetabulofemoral and femoral head-to-neck distances. A balanced group of healthy volunteers was used as control participants. RESULTS Forty-four patients with FAI were evaluated. Ultrasound changes were found in 93.2% of patients, with 63.6% showing some kind of labral abnormality, 40.9% showing articular cartilage abnormalities, 38.6% showing bone contour irregularities, and 29.5% showing osteophytes. The cartilage width and symptom duration were inferior in patients with a damaged articular surface compared with those without (P = .005 and .012, respectively). Patients showing osteophytes on US examinations were slightly older (P = .048). Patients with cam-type FAI were more frequently male (P = .0001) and younger (P = .022) compared with those who had pincer-type FAI and also had a shorter symptom duration (P < .05). Patients with symptoms for 2 years or less had a shorter femoral cartilage width (P = .027). Femoral head-to-neck distances were shorter in patients compared with controls (P = .0005). Only 1 patient in the control group showed some US abnormality. CONCLUSIONS Ultrasound showed detected abnormalities in a significant proportion of patients with symptomatic FAI in early phases of the disease. Additional longitudinal studies are warranted to establish the prognostic importance of these US changes.© 2018 by the American Institute of Ultrasound in Medicine.
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Affiliation(s)
- Cristóbal Orellana
- Department of Rheumatology, Parc Taulí Sabadell University Hospital, Sabadell, Spain
- Parc Taulí Institute for Research and Innovation, Sabadell, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Mireia Moreno
- Department of Rheumatology, Parc Taulí Sabadell University Hospital, Sabadell, Spain
| | - Joan Calvet
- Department of Rheumatology, Parc Taulí Sabadell University Hospital, Sabadell, Spain
- Parc Taulí Institute for Research and Innovation, Sabadell, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
| | - Noemí Navarro
- Department of Rheumatology, Parc Taulí Sabadell University Hospital, Sabadell, Spain
| | - María García-Manrique
- Department of Rheumatology, Parc Taulí Sabadell University Hospital, Sabadell, Spain
| | - Jordi Gratacós
- Department of Rheumatology, Parc Taulí Sabadell University Hospital, Sabadell, Spain
- Parc Taulí Institute for Research and Innovation, Sabadell, Spain
- Department of Medicine, Universitat Autónoma de Barcelona, Barcelona, Spain
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Moreno M, Lisbona MP, Gallardo F, Deza G, Ferran M, Pontes C, Luelmo J, Maymó J, Gratacós J. Ultrasound Assessment of Psoriatic Onychopathy: A Cross-sectional Study Comparing Psoriatic Onychopathy with Onychomycosis. Acta Derm Venereol 2019; 99:164-169. [PMID: 30281142 DOI: 10.2340/00015555-3060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This cross-sectional study evaluated the usefulness of an ultrasound technique in assessment of nail changes in 35 patients with psoriatic onychopathy and 25 with nail dystrophy secondary to onychomycosis. All patients underwent 3 examinations: a complete clinical assessment; a nail ultrasound study; and fungal culture. Nails of patients with psoriatic onychopathy presented a thinner nail plate and nail bed, measured by ultrasound, than did those with onychomycosis. The percentage of patients with a power Doppler signal ?2 at nail bed was significantly higher in psoriatic onychopathy than in onychomycosis, and structural bone lesions were more frequent in psoriatic onychopathy than in onychomycosis. These results suggest that the presence of structural damage and high-power Doppler signal are the main ultrasound findings supporting a diagnosis of psoriatic onychopathy.
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Affiliation(s)
- Mireia Moreno
- Department of Rheumatology, Hospital Universitari Parc Tauli, Sabadell, Spain
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Gratacós J, Pontes C, Juanola X, Sanz J, Torres F, Avendaño C, Vallano A, Calvo G, de Miguel E, Sanmartí R. Non-inferiority of dose reduction versus standard dosing of TNF-inhibitors in axial spondyloarthritis. Arthritis Res Ther 2019; 21:11. [PMID: 30621746 PMCID: PMC6323809 DOI: 10.1186/s13075-018-1772-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 11/19/2018] [Indexed: 02/07/2023] Open
Abstract
Objective The objective was to determine if dose reduction is non-inferior to full-dose TNFi to maintain low disease activity (LDA) in patients already in remission with TNFi, in axial spondyloarthritis. Methods Randomized, parallel, non-inferiority, open-label multicentre clinical trial. Patients were eligible if they had axial spondyloarthritis and had been in clinical remission for ≥ 6 months with any available TNFi (adalimumab, etanercept, infliximab, golimumab) at the dose recommended by product labelling. Patients were randomized by automated central allocation to continue the same TNFi dose schedule, or to reduce the dose by roughly half according to the protocol. The main outcome was the proportion of subjects with LDA after 1 year. Serious adverse reactions or infections were recorded. Results The trial stopped due to end of the funding period, after 126 patients were randomized; 113 patients (84.1% male, mean age (SD) 45.6 (13.0) years) were included in the main per-protocol subset. Non-inferiority was concluded for LDA at 1 year (47/55 (83.8%) patients in the full-dose and 48/58 (81.3%) patients in the reduced-dose arm, adjusted difference (95% CI) − 2.5% (− 16.6% to 11.7%)). Serious adverse reactions or infections were reported in 7/62 patients (11.3%) assigned to full dose and 2/61 patients (3.3%) assigned to reduced dose (p value = 0.164). Conclusion In patients with ankylosing spondylitis in clinical remission for at least 6 months, dose reduction is non-inferior to full TNF inhibitor doses to maintain LDA after 1 year. Serious adverse events may be less frequent with reduced doses. Trial registration EU Clinical Trials Registry, EudraCT 2011–005871-18 and ClinicalTrials.gov, NCT01604629. Electronic supplementary material The online version of this article (10.1186/s13075-018-1772-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jordi Gratacós
- Rheumatology Department, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
| | - Caridad Pontes
- Clinical Pharmacology Unit, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, c/Taulí n°1, 08208, Sabadell, Barcelona, Spain.
| | - Xavier Juanola
- Rheumatology Department, Hospital Universitario de Bellvitge, Universitat de Barcelona, Bellvitge, Barcelona, Spain
| | - Jesús Sanz
- Rheumatology Department, Hospital Universitario Puerta de Hierro- Majadahonda, Madrid, Spain
| | - Ferran Torres
- Medical Statistics core facility, IDIBAPS, Hospital Clínic, Biostatistics Unit, School of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Avendaño
- Clinical Pharmacology Department, Hospital Puerta de Hierro Majadahonda, Madrid, Spain
| | - Antoni Vallano
- Clinical Pharmacology Department, Hospital Universitario de Bellvitge - Universitat de Barcelona, Barcelona, Spain
| | - Gonzalo Calvo
- Clinical Pharmacology Department, Hospital Clínic de Barcelona - Universitat de Barcelona, Barcelona, Spain
| | - Eugenio de Miguel
- Rheumatology Department, Hospital Universitario La Paz, Madrid, Spain
| | - Raimon Sanmartí
- Rheumatology Department, Hospital Clínic de Barcelona - Universitat de Barcelona, Barcelona, Spain
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Aterido A, Cañete JD, Tornero J, Ferrándiz C, Pinto JA, Gratacós J, Queiró R, Montilla C, Torre-Alonso JC, Pérez-Venegas JJ, Fernández Nebro A, Muñoz-Fernández S, González CM, Roig D, Zarco P, Erra A, Rodríguez J, Castañeda S, Rubio E, Salvador G, Díaz-Torné C, Blanco R, Willisch Domínguez A, Mosquera JA, Vela P, Sánchez-Fernández SA, Corominas H, Ramírez J, de la Cueva P, Fonseca E, Fernández E, Puig L, Dauden E, Sánchez-Carazo JL, López-Estebaranz JL, Moreno D, Vanaclocha F, Herrera E, Blanco F, Fernández-Gutiérrez B, González A, Pérez-García C, Alperi-López M, Olivé Marques A, Martínez-Taboada V, González-Álvaro I, Sanmartí R, Tomás Roura C, García-Montero AC, Bonàs-Guarch S, Mercader JM, Torrents D, Codó L, Gelpí JL, López-Corbeto M, Pluma A, López-Lasanta M, Tortosa R, Palau N, Absher D, Myers R, Marsal S, Julià A. Genetic variation at the glycosaminoglycan metabolism pathway contributes to the risk of psoriatic arthritis but not psoriasis. Ann Rheum Dis 2018; 78:annrheumdis-2018-214158. [PMID: 30552173 DOI: 10.1136/annrheumdis-2018-214158] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Psoriatic arthritis (PsA) is a chronic inflammatory arthritis affecting up to 30% of patients with psoriasis (Ps). To date, most of the known risk loci for PsA are shared with Ps, and identifying disease-specific variation has proven very challenging. The objective of the present study was to identify genetic variation specific for PsA. METHODS We performed a genome-wide association study in a cohort of 835 patients with PsA and 1558 controls from Spain. Genetic association was tested at the single marker level and at the pathway level. Meta-analysis was performed with a case-control cohort of 2847 individuals from North America. To confirm the specificity of the genetic associations with PsA, we tested the associated variation using a purely cutaneous psoriasis cohort (PsC, n=614) and a rheumatoid arthritis cohort (RA, n=1191). Using network and drug-repurposing analyses, we further investigated the potential of the PsA-specific associations to guide the development of new drugs in PsA. RESULTS We identified a new PsA risk single-nucleotide polymorphism at B3GNT2 locus (p=1.10e-08). At the pathway level, we found 14 genetic pathways significantly associated with PsA (pFDR<0.05). From these, the glycosaminoglycan (GAG) metabolism pathway was confirmed to be disease-specific after comparing the PsA cohort with the cohorts of patients with PsC and RA. Finally, we identified candidate drug targets in the GAG metabolism pathway as well as new PsA indications for approved drugs. CONCLUSION These findings provide insights into the biological mechanisms that are specific for PsA and could contribute to develop more effective therapies.
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Affiliation(s)
- Adrià Aterido
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Juan D Cañete
- Rheumatology Department, Hospital Clínic de Barcelona and IDIBAPS, Barcelona, Spain
| | - Jesús Tornero
- Rheumatology Department, Hospital Universitario Guadalajara, Guadalajara, Spain
| | - Carlos Ferrándiz
- Dermatology Department, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - José Antonio Pinto
- Rheumatology Department, Complejo Hospitalario Juan Canalejo, A Coruña, Spain
| | - Jordi Gratacós
- Rheumatology Department, Hospital Parc Taulí, Sabadell, Spain
| | - Rubén Queiró
- Rheumatology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Carlos Montilla
- Rheumatology Department, Hospital Virgen de la Vega, Salamanca, Spain
| | | | | | - Antonio Fernández Nebro
- Rheumatology Department, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Santiago Muñoz-Fernández
- Rheumatology Department, Hospital Universitario Infanta Sofía, Universidad Europea, Madrid, Spain
| | - Carlos M González
- Rheumatology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Daniel Roig
- Rheumatology Department, Hospital Moisès Broggi, Barcelona, Spain
| | - Pedro Zarco
- Rheumatology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Alba Erra
- Rheumatology Department, Hospital Sant Rafael, Barcelona, Spain
| | - Jesús Rodríguez
- Rheumatology Department, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Santos Castañeda
- Rheumatology Department, Hospital Universitario La Princesa, IIS La Princesa, Madrid, Spain
| | - Esteban Rubio
- Rheumatology Department, Centro de Salud Virgen de los Reyes, Sevilla, Spain
| | - Georgina Salvador
- Rheumatology Department, Hospital Universitario Mútua de Terrassa, Terrassa, Spain
| | - Cesar Díaz-Torné
- Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Ricardo Blanco
- Rheumatology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - José Antonio Mosquera
- Rheumatology Department, Complejo Hospitalario Hospital Provincial de Pontevedra, Pontevedra, Spain
| | - Paloma Vela
- Rheumatology Department, Hospital General Universitario de Alicante, Alicante, Spain
| | | | - Héctor Corominas
- Rheumatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Rheumatology Department, Hospital Dos de Maig, Barcelona, Spain
| | - Julio Ramírez
- Rheumatology Department, Hospital Clínic de Barcelona and IDIBAPS, Barcelona, Spain
| | - Pablo de la Cueva
- Dermatology Department, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Eduardo Fonseca
- Dermatology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Emilia Fernández
- Dermatology Department, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Lluis Puig
- Dermatology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Esteban Dauden
- Dermatology Department, Hospital Universitario La Princesa, IIS La Princesa, Madrid, Spain
| | | | | | - David Moreno
- Dermatology Department, Hospital Virgen Macarena, Sevilla, Spain
| | | | - Enrique Herrera
- Dermatology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Francisco Blanco
- Rheumatology Department, INIBIC-Hospital Universitario A Coruña, A Coruña, Spain
| | | | - Antonio González
- Instituto de Investigación Sanitaria Hospital Clínico Universitario de Santiago, Santiago de Compostela, Spain
| | | | | | | | | | | | - Raimon Sanmartí
- Rheumatology Department, Hospital Clínic de Barcelona and IDIBAPS, Barcelona, Spain
| | | | | | - Sílvia Bonàs-Guarch
- Barcelona Supercomputing Centre (BSC), Joint BSC-CRG-IRB Research Program in Computational Biology, Barcelona, Spain
| | - Josep Maria Mercader
- Barcelona Supercomputing Centre (BSC), Joint BSC-CRG-IRB Research Program in Computational Biology, Barcelona, Spain
| | - David Torrents
- Barcelona Supercomputing Centre (BSC), Joint BSC-CRG-IRB Research Program in Computational Biology, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain
| | - Laia Codó
- Life Sciences Department, Barcelona Supercomputing Centre, Barcelona, Spain
| | - Josep Lluís Gelpí
- Life Sciences Department, Barcelona Supercomputing Centre, Barcelona, Spain
| | | | - Andrea Pluma
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Maria López-Lasanta
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Raül Tortosa
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Nuria Palau
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Devin Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Richard Myers
- HudsonAlpha Institute for Biotechnology, Huntsville, Alabama, USA
| | - Sara Marsal
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Antonio Julià
- Rheumatology Research Group, Vall d'Hebron Research Institute, Barcelona, Spain
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Moreno M, Gratacós J, Navarro-Compán V, de Miguel E, Font P, Clavaguera T, Linares LF, Joven B, Juanola X. Should over-treatment of axial spondyloarthritis with biologics remain a concern after the issue of the new ASAS criteria? Data from REGISPONSERBIO (Spanish Register of Biological Therapy in Spondyloarthritides). Clin Exp Rheumatol 2018; 36:1038-1042. [PMID: 29745878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 03/05/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To study whether disease status at treatment initiation has changed after the issue of the ASAS classification criteria. METHODS REGISPONSERBIO registers patients with axial spondyloarthritis (axSpA) on biological treatment since 2013. It includes patients starting biological treatment (incident) or already on biological therapies (prevalent). Patients in both groups were compared in terms of: age at disease onset and at treatment start, disease duration, gender, HLA-B27, body mass index (BMI), BASDAI, BASFI, C-reactive protein, ESR, metrological data, ASQoL, WAPAI, extra-articular manifestations, comorbidities, radiological study, type of biological treatment and concomitant treatments. RESULTS 256 patients were included, of whom 174 (65%) were already on biologic therapy. Compared to incident patients, prevalent patients started treatment with longer disease duration (15 vs. 8.6 years; p<0.001), a higher proportion of them were men (83% vs. 67%; p=0.01), a smaller proportion of them showed non-radiographic axial spondylarthritis (nr-axSpA)(17% vs. 32%; p<0.01), and a higher proportion had HLAB27 (85% vs. 73%; p=0.02). There were no statistically significant differences in terms of disease activity, degree of disability, quality of life, or prevalence of extra-articular manifestations. CONCLUSIONS Data suggest that, after the issue of the new classification criteria for SpA, biological therapy is being administered earlier than previously in SpA patients and in a higher proportion of patients with nr-axSpA. However, this change in prescribing profile, apparently, has not caused an over-treatment, as patients do not seem to have a lower disease burden than prior to the issue of the criteria.
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Affiliation(s)
- Mireia Moreno
- Rheumatology Department, University Hospital Parc Taulí, Sabadell, Universitat Autonoma de Barcelona, Spain
| | - Jordi Gratacós
- Rheumatology Department, University Hospital Parc Taulí Sabadell, Universitat Autonoma de Barcelona, Spain.
| | | | | | - Pilar Font
- Rheumatology Department, University Hospital Reina Sofía, Córdoba, Spain
| | | | | | - Beatriz Joven
- Rheumatology Department, University Hospital Doce de Octubre, Madrid, Spain
| | - Xavier Juanola
- Rheumatology Department, University Hospital Bellvitge, Barcelona, Spain
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Gratacós J, Díaz del Campo Fontecha P, Fernández-Carballido C, Juanola Roura X, Linares Ferrando LF, de Miguel Mendieta E, Muñoz Fernández S, Rosales-Alexander JL, Zarco Montejo P, Guerra Rodríguez M, Navarro Compán V. Recomendaciones de la Sociedad Española de Reumatología sobre el uso de terapias biológicas en espondiloartritis axial. ACTA ACUST UNITED AC 2018; 14:320-333. [DOI: 10.1016/j.reuma.2017.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 08/21/2017] [Indexed: 12/14/2022]
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Navarro-Compán V, Otón T, Loza E, Almodóvar R, Ariza-Ariza R, Bautista-Molano W, Burgos-Vargas R, Collantes-Estévez E, de Miguel E, González-Fernández C, Gratacós J, Ibáñez S, Juanola X, Maldonado-Cocco J, Moltó A, Mulero J, Pacheco-Tena C, Ramos-Remus C, Sanz-Sanz J, Valle-Oñate R, Zarco P, Marzo-Ortega H. Assessment of SpondyloArthritis International Society (ASAS) Consensus on Spanish Nomenclature for Spondyloarthritis. ACTA ACUST UNITED AC 2018; 16:333-338. [PMID: 30193774 DOI: 10.1016/j.reuma.2018.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To develop a consensus to standardize the use of Spanish terms, abbreviations and acronyms in the field of spondyloarthritis (SpA). METHODS An international task force comprising all native Spanish-speaking Assessment of SpondyloArthritis International Society (ASAS) members, the executive committee of Grupo para el estudio de la Espondiloartritis de la Sociedad Española de Reumatología (GRESSER), two methodologists, two linguists from the Real Academia Nacional de Medicina de España (RANM) and two patients from the Spanish Coordinator of Spondylitis Associations (CEADE) was established. A literature review was performed to identify the conflicting terms/abbreviations/acronyms in SpA. This review examined written sources in Spanish including manuscripts, ICF and ICD, guidelines, recommendations and consensuses. This was followed by a nominal group meeting and a three-round Delphi. The recommendations from the RANM based on the Panhispanic dictionary were followed throughout the process. RESULTS Consensus was reached for 46 terms, abbreviations or acronyms related to the field of SpA. A Spanish translation was accepted for 6 terms and 6 abbreviations to name or classify the disease, and for 6 terms and 4 abbreviations related to SpA. It was agreed not to translate 15 acronyms into Spanish. However, when mentioning them, it was recommended to follow this structure: type of acronym in Spanish and acronym and expanded form in English. With regard to 7 terms or abbreviations attached to acronyms, it was agreed to translate only the expanded form and a translation was also selected for each of them. CONCLUSIONS Through this standardization, it is expected to establish a common use of the Spanish nomenclature for SpA. The implementation of this consensus across the community will be of substantial benefit, avoiding misunderstandings and time-consuming processes.
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Affiliation(s)
| | - Teresa Otón
- Instituto de Salud Musculoesquelética, Madrid, España
| | | | | | | | | | | | | | | | | | - Jordi Gratacós
- Hospital Universitario Parc Taulí de Sabadell, I3PT, Universitat Autònoma de Barcelona (UAB), Barcelona, España
| | - Sebastián Ibáñez
- Facultad de Medicina Clínica Alemana-Universidad del Desarrollo, Santiago de Chile, Chile
| | - Xavier Juanola
- Hospital Universitario de Bellvitge, IDIBELL, Universitat de Barcelona, Barcelona, España
| | | | - Anna Moltó
- Hôpital Cochin Hospital, Assistance Publique Hôpitaux de Paris-INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité, París, Francia
| | - Juan Mulero
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Cesar Ramos-Remus
- Unidad de Investigación en Enfermedades Cronicodegenerativas, Ciudad de México, México
| | - Jesús Sanz-Sanz
- Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | | | - Pedro Zarco
- Hospital Universitario Fundación Alcorcón, Madrid, España
| | - Helena Marzo-Ortega
- NIHR Biomedical Research Centre, Leeds Teaching Hospitals Trust and Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, Reino Unido
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Almodovar R, Torre Alonso JC, Batlle E, Castillo C, Collantes-Estevez E, de Miguel E, González S, Gratacós J, Hernández A, Juanola X, Linares LF, Moreno MJ, Moreno M, Navarro-Compán V, Rodríguez Lozano C, Sanz J, Sellas A, Loza E, Zarco P. Desarrollo de un cuadro de actuación para la evaluación de pacientes con espondiloartritis axial y artritis psoriásica en la práctica diaria: proyecto ONLY TOOLS. ACTA ACUST UNITED AC 2018; 14:155-159. [DOI: 10.1016/j.reuma.2016.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/01/2016] [Accepted: 12/05/2016] [Indexed: 11/28/2022]
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Gratacós J, Luelmo J, Rodríguez J, Notario J, Marco TN, de la Cueva P, Busquets MP, Font MG, Joven B, Rivera R, Vega JLA, Álvarez AJC, Parera RS, Carrascosa JCR, Martínez FJR, Sánchez JP, Olmos CF, Pujol C, Galindez E, Barrio SP, Arana AU, Hergueta M, Coto P, Queiro R. Standards of care and quality indicators for multidisciplinary care models for psoriatic arthritis in Spain. Rheumatol Int 2018; 38:1115-1124. [PMID: 29417210 DOI: 10.1007/s00296-018-3986-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 01/17/2018] [Indexed: 11/25/2022]
Abstract
To define and give priority to standards of care and quality indicators of multidisciplinary care for patients with psoriatic arthritis (PsA). A systematic literature review on PsA standards of care and quality indicators was performed. An expert panel of rheumatologists and dermatologists who provide multidisciplinary care was established. In a consensus meeting group, the experts discussed and developed the standards of care and quality indicators and graded their priority, agreement and also the feasibility (only for quality indicators) following qualitative methodology and a Delphi process. Afterwards, these results were discussed with 2 focus groups, 1 with patients, another with health managers. A descriptive analysis is presented. We obtained 25 standards of care (9 of structure, 9 of process, 7 of results) and 24 quality indicators (2 of structure, 5 of process, 17 of results). Standards of care include relevant aspects in the multidisciplinary care of PsA patients like an appropriate physical infrastructure and technical equipment, the access to nursing care, labs and imaging techniques, other health professionals and treatments, or the development of care plans. Regarding quality indicators, the definition of multidisciplinary care model objectives and referral criteria, the establishment of responsibilities and coordination among professionals and the active evaluation of patients and data collection were given a high priority. Patients considered all of them as important. This set of standards of care and quality indicators for the multidisciplinary care of patients with PsA should help improve quality of care in these patients.
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Affiliation(s)
- Jordi Gratacós
- Servicio de Reumatología, Rheumatology Department, Hospital universitario Parc Taulí de Sabadell, I3PT, UAB, Parc Taulí, 1 Sabadell, 08208, Barcelona, Spain.
| | - Jesús Luelmo
- Servicio de Dermatología, Hospital universitario Parc Taulí de Sabadell, I3PT, UAB, Barcelona, Spain
| | - Jesús Rodríguez
- Servicio de Reumatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Jaume Notario
- Servicio de Dermatología, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Teresa Navío Marco
- Servicio de Reumatología, Universitario el Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Pablo de la Cueva
- Servicio de Dermatología, Universitario el Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - Mercè García Font
- Servicio de Dermatología, Hospital Mutua de Terrassa, Barcelona, Spain
| | - Beatriz Joven
- Servicio de Reumatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raquel Rivera
- Servicio de Dermatología, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Ricardo Sánchez Parera
- Servicio de Reumatología, Complejo Hospitalario Universitario de Granada, Granada, Spain
| | | | | | - José Pardo Sánchez
- Servicio de Dermatología, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain
| | - Carlos Feced Olmos
- Servicio de Reumatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Conrad Pujol
- Servicio de Dermatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Eva Galindez
- Servicio de Reumatología, Hospital de Basurto, Bilbao, Bizkaia, Spain
| | | | | | | | - Pablo Coto
- Servicio de dermatología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Rubén Queiro
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Spain
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Calvet J, Orellana C, Galisteo C, García-Manrique M, Navarro N, Caixàs A, Larrosa M, Gratacós J. Clinical and ultrasonographic features associated to response to intraarticular corticosteroid injection. A one year follow up prospective cohort study in knee osteoarthritis patient with joint effusion. PLoS One 2018; 13:e0191342. [PMID: 29351562 PMCID: PMC5774783 DOI: 10.1371/journal.pone.0191342] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 01/03/2018] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES Intraarticular injection is used for pain relief in knee osteoarthritis (OA), but there is not a well defined profile of patient who could get more benefit from it. The purpose of this study was to evaluate the frequency of pain relief at one year after corticosteroids intraarticular injection and to identify clinical factors associated to response in patients with knee osteoarthritis with joint effusion. METHODS One-year prospective cohort study of patients with knee OA with joint effusion confirmed by ultrasound. An intraarticular injection was performed following a clinical protocol. Anthropometric measurements, laboratory parameters, clinical severity, ultrasound parameters and radiological severity were collected. Response regarding pain and presence of synovial fluid on ultrasound at one month and at one year were evaluated. Clinical responder were consider in subjects with enough improvement to carry out normal daily activities with pain VAS<40mm. RESULTS One hundred and thirty-two patients were included.A significant number of patients (61.4%) improved pain at one year following the protocol established in this study. Pain and ultrasound synovial fluid at one month appeared to predict the response at one year. The Lequesne index and the percentage of body fat were independently associated to pain at one year while the Lequesne index and ultrasound synovial hypertrophy were independently related to the presence of synovial fluid at one year. CONCLUSIONS The status regarding pain or ultrasound synovial fluid at one month after an intraarticular joint injection appeared to predict the status at one year in patients with knee osteoarthritis and synovial effusion.
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Affiliation(s)
- Joan Calvet
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Cristóbal Orellana
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Carlos Galisteo
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - María García-Manrique
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Noemí Navarro
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Assumpta Caixàs
- Endocrinology and Nutrition Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Marta Larrosa
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
| | - Jordi Gratacós
- Rheumatology Department, Parc Taulí Sabadell University Hospital. I3PT Research Institute (UAB), Sabadell, Barcelona, Spain
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Arévalo M, Moreno M, Gratacós J. Interstitial granulomatous dermatitis associated with lupus: A case report. Reumatol Clin 2017; 13:367-368. [PMID: 28359766 DOI: 10.1016/j.reuma.2017.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/18/2017] [Accepted: 01/19/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Marta Arévalo
- Servicio de Reumatología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, España.
| | - Mireia Moreno
- Servicio de Reumatología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, España
| | - Jordi Gratacós
- Servicio de Reumatología, Hospital Universitari Parc Taulí de Sabadell, Sabadell, Barcelona, España
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Navarro-Compán V, Plasencia-Rodríguez C, de Miguel E, Diaz Del Campo P, Balsa A, Gratacós J. Switching biological disease-modifying antirheumatic drugs in patients with axial spondyloarthritis: results from a systematic literature review. RMD Open 2017; 3:e000524. [PMID: 29071119 PMCID: PMC5640114 DOI: 10.1136/rmdopen-2017-000524] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/30/2017] [Accepted: 09/15/2017] [Indexed: 01/21/2023] Open
Abstract
Objectives First, to investigate if switching biological disease-modifying antirheumatic drugs (bDMARDs) after the failure to prior bDMARD is efficacious in patients with axial spondyloarthritis (axSpA). Second, to evaluate the influence on this efficacy of (1) the reason to discontinue prior tumour necrosis factor inhibitor (TNFi), (2) changing the type of TNFi and (3) changing the target. Methods A systematic literature review until January 2017 was performed using Medline, EMBASE and Cochrane databases. Longitudinal studies assessing clinical response after switching bDMARDs in patients with axSpA were analysed. Results In total, 9 studies out of 1862 retrieved citations were included. Overall, the level of evidence was poor. In these studies, all patients received a TNFi as first bDMARD, 1956 patients switched to a second bDMARD (97% TNFi and 3% interleukin-17 inhibitors (IL-17i)) and 170 to a third bDMARD (all TNFi). Clinical response (Bath Ankylosing Spondylitis Disease Activity Index 50) after a second TNFi was achieved by 25%–56% of patients compared with 50%–72% after the first TNFi. Also, 47% of patients switching to IL-17i after a TNFi responded (Assessment of SpondyloArthritis international Society 40) compared with 66% in those who received IL-17i as first line. The response after switching was not influenced by the reason to discontinue, type of prior TNFi or changing the target. Conclusions In patients with axSpA, switching to a second bDMARD (a TNFi or IL-17i) after prior TNFi is efficacious. Nevertheless, the clinical response is lower than the observed in patients naive to bDMARD. So far, the reason to discontinue prior bDMARD or the type of bDMARD has not been identified as predictor of response. Published evidence for switching to a third bDMARD is lacking.
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Affiliation(s)
| | | | - Eugenio de Miguel
- Department of Rheumatology, University Hospital La Paz, IdiPAZ, Madrid, Spain
| | | | - Alejandro Balsa
- Department of Rheumatology, University Hospital La Paz, IdiPAZ, Madrid, Spain
| | - Jordi Gratacós
- Department of Rheumatology, University Hospital Parc Taulí (I3PT), UAB, Sabadell, Barcelona, Spain
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Perrotti PP, Aterido A, Fernández-Nebro A, Cañete JD, Ferrándiz C, Tornero J, Gisbert JP, Domènech E, Fernández-Gutiérrez B, Gomollón F, García-Planella E, Fernández E, Sanmartí R, Gratacós J, Martínez-Taboada VM, Rodríguez-Rodríguez L, Palau N, Tortosa R, Corbeto ML, Lasanta ML, Marsal S, Julià A. Genetic variation associated with cardiovascular risk in autoimmune diseases. PLoS One 2017; 12:e0185889. [PMID: 28982122 PMCID: PMC5628882 DOI: 10.1371/journal.pone.0185889] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 09/21/2017] [Indexed: 01/26/2023] Open
Abstract
Autoimmune diseases have a higher prevalence of cardiovascular events compared to the general population. The objective of this study was to investigate the genetic basis of cardiovascular disease (CVD) risk in autoimmunity. We analyzed genome-wide genotyping data from 6,485 patients from six autoimmune diseases that are associated with a high socio-economic impact. First, for each disease, we tested the association of established CVD risk loci. Second, we analyzed the association of autoimmune disease susceptibility loci with CVD. Finally, to identify genetic patterns associated with CVD risk, we applied the cross-phenotype meta-analysis approach (CPMA) on the genome-wide data. A total of 17 established CVD risk loci were significantly associated with CVD in the autoimmune patient cohorts. From these, four loci were found to have significantly different genetic effects across autoimmune diseases. Six autoimmune susceptibility loci were also found to be associated with CVD risk. Genome-wide CPMA analysis identified 10 genetic clusters strongly associated with CVD risk across all autoimmune diseases. Two of these clusters are highly enriched in pathways previously associated with autoimmune disease etiology (TNFα and IFNγ cytokine pathways). The results of this study support the presence of specific genetic variation associated with the increase of CVD risk observed in autoimmunity.
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Affiliation(s)
- Pedro P. Perrotti
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Medicine, University of Barcelona, Barcelona, Spain
| | - Adrià Aterido
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Antonio Fernández-Nebro
- UGC Reumatología, Instituto de Investigación Biomédica (IBIMA), Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, Spain
| | - Juan D. Cañete
- Hospital Clínic de Barcelona and IDIBAPS, Barcelona, Spain
| | | | - Jesús Tornero
- Hospital Universitario Guadalajara, Guadalajara, Spain
| | - Javier P. Gisbert
- CIBERehd, Madrid, Spain
- Hospital Universitario de la Princesa and IIS-IP, Madrid, Spain
| | - Eugeni Domènech
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain
- CIBERehd, Madrid, Spain
| | | | - Fernando Gomollón
- CIBERehd, Madrid, Spain
- Hospital Clínico Universitario, Zaragoza, Spain
| | | | | | | | | | | | | | - Núria Palau
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Raül Tortosa
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Mireia L. Corbeto
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - María L. Lasanta
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
| | - Sara Marsal
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- * E-mail: (AJ); (SM)
| | - Antonio Julià
- Rheumatology Research Group, Vall d’Hebron Research Institute, Barcelona, Spain
- * E-mail: (AJ); (SM)
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Almodóvar R, Gratacós J, Zarco P. Information needs of patients with spondyloarthritis about their disease. ACTA ACUST UNITED AC 2017; 14:367-371. [PMID: 28583786 DOI: 10.1016/j.reuma.2017.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE 1. To describe the information provided to, or inquired about, by patients with axial spondyloarthritis and psoriatic arthritis. 2. To analyze improvements. METHODS Analysis of the discourse of focus groups (with patients, some of them from patient associations, and rheumatologists). The discussion included the identification of elements that shape the reality being studied, describing the relationship among them and summarizing the results by: 1)thematic segmentation; 2)categorization according to situations, relationships, opinions, feelings or others; 3)coding of the various categories, and 4)interpretation of results. Representativeness was ensured by using a typological framework. RESULTS Rheumatologists are the main source of information. Patient associations have a fundamental role and are well-regarded. Internet is used with caution due to its limited reliability. Patients are interested in: disease characteristics and treatments, the course and prognosis, and social, administrative and other kinds of support. More information is needed (objective and constructive, avoiding a catastrophic tone); it should be provided progressively, adjusted to patients features and needs. There are areas for improvement including: the standardization and updating of contents (based on scientific evidence), the optimization of informative materials (written, electronic), and other resources such as nursing and primary care. CONCLUSIONS Rheumatologists are the main and most reliable source of information for patients with spondyloarthritis and psoriatic arthritis. Patient associations have an important role and are well-regarded. Changes in the content, format and sources of information are required.
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Affiliation(s)
- Raquel Almodóvar
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.
| | - Jordi Gratacós
- Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Pedro Zarco
- Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España
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Torre-Alonso JC, Carmona L, Moreno M, Galíndez E, Babío J, Zarco P, Linares L, Collantes-Estevez E, Barrial MF, Hermosa JC, Coto P, Suárez C, Almodóvar R, Luelmo J, Castañeda S, Gratacós J. Identification and management of comorbidity in psoriatic arthritis: evidence- and expert-based recommendations from a multidisciplinary panel from Spain. Rheumatol Int 2017; 37:1239-1248. [DOI: 10.1007/s00296-017-3702-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/14/2017] [Indexed: 02/08/2023]
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50
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Queiro R, Coto P, Rodríguez J, Notario J, Navío Marco T, de la Cueva P, Pujol Busquets M, García Font M, Joven B, Rivera R, Alvarez Vega JL, Chaves Álvarez AJ, Sánchez Parera R, Ruiz Carrascosa JC, Rodríguez Martínez FJ, Pardo Sánchez J, Feced Olmos C, Pujol C, Galindez E, Pérez Barrio S, Urruticoechea Arana A, Hergueta M, Luelmo J, Gratacós J. Modelos de atención multidisciplinar en pacientes con artritis psoriásica en España. ACTA ACUST UNITED AC 2017; 13:85-90. [DOI: 10.1016/j.reuma.2016.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 02/16/2016] [Accepted: 03/03/2016] [Indexed: 11/24/2022]
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